Corcoran, Andrew J it
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Andrew J.Corcoran Male
Date of Death Age If Veteran of U.S.Armed Farces,
01/07/2023 60 Years War or Dates
F. Place of Death Hospital,Institution or
WZ City,Town or Village Warrensburg Town Street Address 102 Cross Road,Warrensburg Town,New York 12885
Ci Manner of Death ❑X Natural Cause Accident Homicide OSuicide nUndetermined n Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 David Slingerland MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 1
Burial Date Cemetery,Crematory or Facility Name
01/10/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
F- Hold Address
(A
0
Date Point of
(/)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment E
Date Cemetery Address
Date Cemetery Address
❑Reinterment
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
F. Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/10/2023 Registrar of Vital Statistics TamelaMGloyrl(ElectronicallySigned)
(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 4.--._
-
WDate of Disposition r I It 1 Z3 Place of Disposition -F..L.
2 (address)
W
NCC (section) � (lot number/ < (grave number)
8 Name o
f Sexton or Person in Charge of P emises I
ZJr (p! seprinr)
LU Signature / _ Title COE 111 A
fy
DOH-1555(07/18)p 1 of 2
>i Y 5 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#