Guay, Erwin Lee NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records ! } Burial - Transit Permit
Name First Middle Last Sex
Erwin Lee Guay Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/13/2023 83 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center
'p Manner of Death ❑X Natural Cause IllAccident Homicide EI Suicide Undetermined Pending
I—ICircumstances Investigation
0LU Medical Certifier Name Title
Zvi Batash MD
Address
3230 Church St,Valatie Village,New York 12184
Death Certificate Filed Village Of Valatie District Number Register Number
City,Town or Village 1023 8
Burial Date Cemetery,Crematory or Facility Name
02/16/2023 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
EiDonation
ElRemoval Date Place Removed
and/or and/or Held
Hold Address
N
0
a Date Point of
t/) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
�.. Remains are Shipped,If Other than Above
g Address
CC
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2023 Registrar of Vital Statistics Barbara Ann Tischer(ECectronica1ySigned)
(signature)
District Number 1023 Place Village Of Valatie
I certify that the remains of the decedent identified above were disposed of in accordance
,'with this permit on:
W Date of Disposition 2/QZeZ3 Place of Disposition Pt,i,)e V 1 e,,) C r i r-
2 (address)
W
N (section) _ (11 number) (grave number)
SName of Sexton or Person in Charge of miss KA//y7Unl t �ri
Z (please print)
W Signature // Title ( $—�`��
DOH-1555(07/18)p 1 of 2 v
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#