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Elvin, Keith Linley
NEW YORK STATE DEPARTMENT OF HEALTH #13� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Keith Linley Elvin Male Date of Death Age If Veteran of U.S.Armed Forces, 02/03/2023 84 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death Z Natural Cause Accident 0 Homicide OSuicide nUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title t7 Tanya Finch NP Address 9 Carey Road,Queensbury Town,New York 12804 DeaEth Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 72 Burial Date Cemetery,Crematory or Facility Name 02/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 C. Date Point of U)❑Transportation Shipment p by Common Carrier Destination Disinterment El Date Cemetery Address IIIReinterment 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 2 Address CC W 1- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2023 Registrar of Vital Statistics Megan No[in(E(ectronicafySigned) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 2111 Z, Place of Disposition -17 0.c , 2 (address) W NCC (section) 71 (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premise ' ease print/ (/f/ itle ` mF'/D LLJ Signature c �l DOH-1555(07/18)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#