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Vargas, Hector It ND NEW YORKSTATE DEPARTMENT OF HEALTH = 4 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Hector Vargas Male Date of Death Age If Veteran of U.S.Armed Forces, 03/02/2023 78 Years War or Dates Vietnam i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation ILI p• Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending 0 Circumstances Investigation W Medical Certifier Name Title O Wendy Steinhacker PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 127 Burial Date Cemetery,Crematory or Facility Name 03/08/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury,New York Donation ZO❑Removal Date Place Removed and/or and/or Held i Hold Address N 0 O. Date Point of N ElTransportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 F Remains are Shipped,If Other than Above 2 Address IX W O Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/08/2023 Registrar of Vital Statistics 96fegan Nolin(ECectronicalTy Signed) (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: IW Date of Disposition 3)ly iv, Place of Disposition _- 4,,,_.._� 2 (address) W Ir N (section) Art-( lot number) (grave number) S Name of Seicton or Person in Charge remises � lease print) W Signature <1�' Title �`� ( DOH-1555(07/18)p 1 of 2 s: J: R7 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 etery Representing the funeral home named on burial permit Funeral Directors Reg.or License#