Packard, Robert Henry (2) {,\.1:....._7f)- 4 70
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Robert Henry Packard Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/05/2022 80 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Warrensburg Town Street Address 1544 Viele Pond Road,Warrensburg Town,New York 12885
UJ
p Manner of Death ❑Natural Cause Accident Ej Homicide 0Suicide Undetermined Ri Pending
IIJ
Circumstances Investigation
W Medical Certifier Name Title
O Paul Bachman MD
Address
3767 Main Street,Warrensburg Town, New York 12885
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 23
Burial Date Cemetery,Crematory or Facility Name
MINIM 12/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZZ❑Removal, Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
Cl)ETransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
El 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
H Remains are Shipped,If Other than Above
5 Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2022 Registrar of Vital Statistics Tame&a.9l2 Lloyd-(E(ectronica1TySigned)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition IZJg I it. Place of Disposition t,
LLI (address)
W
N CC (section)(section) 7 ( number) (grave number)
L'
8 Name of Sexton or Person in Charge f Premises "kr'!L_, —'tom H
z
(please print)
...."2—
W Signature Title Ci ►loq°K
DOH-1555(07/18)p 1 of 2
"'";, b 4 t;9
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#