Hewitt, Franklin A 1E) 4 car
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Franklin A.Hewitt Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/21/2022 91 Years War or Dates 50-52
Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek
`p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined IT Pending
Circumstances Investigation
W Medical Certifier Name Title
0 James Hindson MD
Address
112 Ski Bowl Rd,Johnsburg Town, New York 12853
Death Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 29
Burial Date Cemetery,Crematory or Facility Name
11/28/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
(/) Transportation
by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
Q
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/28/2022 Registrar of Vital Statistics jean M Comstock(ECectronicaCCy Signed)
(signature)
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition j ?q I ZL Place of Disposition ,./a—
2 (address)
W
CC CC (section) //, lot number/ (grave number)
Name of Sexton or Person in Charge of remises
lease print)
w rl^�Km H rat2
Signature — Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#