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Meyer, Wayne Richard NEW YORK STATE DEPARTMENT OF HEALTH E � f 700 Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Wayne Richard Meyer Male Date of Death Age If Veteran of U.S.Armed Forces, 02/27/2023 75 Years War or Dates 1968-1971 1... Place of Death Hospital,Institution or LU City,Town or Village Johnsburg Town Street Address 394 River Road,Johnsburg Town,New York 12862 p Manner of Death IZI Natural Cause Accident Homicide ESuicide Undetermined Pending LIU U Circumstances Investigation LI Medical Certifier Name Title Kate Sauer-Jones PA Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 6 Burial Date Cemetery,Crematory or Facility Name 03/01/2023 Pine View Crematory _Entombment Address - ©Cremation Queensbury Town,New York Donation ZEl Removal Date Place Removed H and/or and/or Held N Hold Address 0 0- Date Point of (/)ElTransportation CI by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address v 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom ii- Remains are Shipped,If Other than Above Address CC IJJ a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2023 Registrar of Vital Statistics Jean M Comstock(E(ectronicalry Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I W Date of Disposition 3)2 1 23 Place of Disposition N V... 0. - g (address) W N CC (section) (lot number) (grave number) 0 0 Name of Sexton or Person in Charge of Premises L, Z please print/ W Signature Title g l'rvnm , (� DOH-1555(o7/t8)p 1 of 2 f (F,3 tp , 9...�t 1 r V 4i: 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#