Swinton, Kenneth F )4 16g,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kenneth F.Swinton Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2022 60 Years War or Dates
Place of Death Hospital,Institution or
Z
City,Town or Village Warrensburg Town Street Address 3664 Main Street 7,Warrensburg Town,New York 12885
p Manner of Death I1 Natural Cause Accident I:IHomicide Duicide illUndetermined riPending
Circumstances Investigation
W Medical Certifier Name Title
0 Janine Gadjo NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 24
Burial Date Cemetery,Crematory or Facility Name
12/09/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
V) Transportation
0 by Common Shipment
Carrier Destination
Date Cemetery Address
❑DisintermentEI
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
�... Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2022 Registrar of Vital Statistics Pamela 9K GCoyd(Electronically Signed)
(s)gnature)
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:
Fr
Z Date of Disposition /2-/9-toZL Place of Disposition "P; „/e i1 eu r Cr-p�,/��;
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2 /address/-
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CC CC (section) (lot nu ber) - (grave number)
0 Name of Sexton or Person in Charge f Prem.ses "—R/9Yl1lO,t
Z (please print)
W Signature l GO- Title &,{ e'er
g
DOH-1555(07/18)p t of 2
0 1.6 4 7
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
''ne View Cemetery Representing the funeral home named on burial permit
.1 Funeral Directors Reg.or License#