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Baker, Andrew Matthew I _LF) NEW YORK STATE DEPARTMENT OF HEALTH • -f j/ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Andrew Matthew Baker Male Date of Death Age If Veteran of U.S.Armed Forces, 12/02/2022 8 Days War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital LLI p Manner of Death 0 Natural Cause Accident Homicide Suicide nUndetermined nPending Vff ''Circumstances I 'Investigation W Medical Certifier Name Title C3 Rehman Chowdhry MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 2820 Burial Date Cemetery,Crematory or Facility Name 12/06/2022 Pine View Crematory Entombment Address "Cremation Queensbury Town,New York Donation 2 Removal Date Place Removed 0❑and/or and/or Held H Hold Address N 0 a Date Point of Cl) Transportation p by Common Shipment Carrier Destination Ei Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom ;Remains are Shipped,If Other than Above Address re W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2022 Registrar of Vital Statistics Danie&Scillerpr gkctronicall Signed) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 21----- 1.11~Z Date of Disposition IZ IZ Place of Disposition ..4 address) W N (section)CC (lot number)L (grave number) © Name of Sexton or Person in C3oPremises 1 ` z (pleeaprint) W Signature Title ` w�� DOH-1555(o7/18)p 1 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#