Kendall. Michael ' L
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
•,
Name First Middle Last Sex
Michael Kendall Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/17/2022 67 Years War or Dates
E,. Place of Death • Hospital,Institution or
Z_City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death EI Natural Cause Accident 0 Homicide Duicide FlUndetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 585
K Burial Date Cemetery,Crematory or Facility Name
11/28/2022 Pine View Cemetery
Entombment
— Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
CO
0
d Date Point of
(/)ElTransportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
0 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
~ Remains are Shipped,If Other than Above
5 Address
Q
W
I' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/22/2022 Registrar of Vital Statistics Megan Nolsn((Yectronical6,Signed
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
Z Date of Disposition \k.Dp, 3D Place of Disposition Q k, Du6,1e., _p__CRIj (j`.le.' n t - h. ' t
ILI
(address)
Li
N « ��G I
Q (section) /l (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises �rIn\e- Q.c2\e-Jr1r-
Z (please print)
IiJ Signature /dam Title pax"l t�print) 11�
.c f
DOH-1555(o7/A8)p 1 of 2
Public Health Law Sec. 4145(2b)
012954
Receipt
Human remains of delivered on \, ,,. , 20
// ��
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,Pine View Cemetery Representinglthe funeral home named on burial permit
Official Funeral Directors Reg.or License# "1/- 't"
Kendall �
NAME Michael Kendal Age:67 (ivLF1
Lot Owner: Michael Kendall
Lot# Horicon 14 G Grave# 1
Case: Concrete
Died: 1 1 .1 7 .2 2 Interred: 1 1 .28.22
Funeral Home: Baker FH
Cemetery: Pine View