Baehm, Raymond Edwin (,1 :9 16 7 I
NEW YORK STATE DEPARTMENT OF HEALTH 4---- - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last I Sex
l Male
Raymond Edwin Baehm
Date of Death Age If Veteran of U.S.Armed Forces,
08/17/2022 88 Years War or Dates 1953-1955
Place of Death Hospital,Institution or
Z
City,Town or Village Clifton Park Town Street Address 1 Emma Lane,Clifton Park Town,New York 12065
Manner of Death Undetermined Pending
Q Natural Cause Accident Ei Homicide Suicide ❑Circumstances Investigation
W
U Title
LU C Medical Certifier Name
Donna Heffeman MD
Address
16 Crimson Oak Ct,Schenectady,New York 12309
Death Certificate Filed District Number Register Number
Town Of Clifton Park 4552 91
City,Town or Village
Burial Date Cemetery,Crematory or Facility Name
08/22/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
}- Hold Address
N
0 Date Point of
N nTransportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1-- Remains are Shipped,If Other than Above
M Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/19/2022 Registrar of Vital Statistics Teresa(Bro6ston(ECectronicafy Signed)
(signature/
District Number 4552 Place Town Of Clifton Park
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition �a3?�ZL Place of Disposition If " J e J,.�� 6r �
m /address/
W
Cl)CC (sedan) (lot umber)
(grave number)
0 Name of Sexton or Person in Charge o remiss r I<(4 11_n�4� �Ot�c
z r (please print)
111 Signature Title _Q�x!Tt K9�
DOH-1555(o7/181 p i of 2
1
1 Tk5.4
9 Public Health Law Sec. 4145(2b)
1 Receipt
Human remains of ' .- -. delivered on , 20
'Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ':_ t.