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Canavan Sr., Raymond Francis (ILT____.") it ?tit,NEW YORK STATE DEPARTMENT OF HEALTHBureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Raymond Francis Canavan Sr. Male Date of Death Age If Veteran of US.Armed Forces, 03/12/2023 93 Years War or Dates 1950-1953 Place of Death Hospital,Institution or !LJ City,Town or Village Queensbury Town Street Address 87 Cedar Court,Queensbury Town,New York 12804 O Manner of Death Z Natural Cause Accident ❑Homicide 0Suicide ❑Undetermined El Pending ILI Circumstances Investigation O• Medical Certifier Name Title Sean Campanie NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 36 • Burial Date Cemetery,Crematory or Facility Name R 03/13/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of N❑Transportation p by Common Shipment Carrier Destination EIDisinterment 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 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 03/13/2023 Registrar of Vital Statistics Caroline 2fi(degarde Barber(ECectronicaffy Signed) /signature/ District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 31jb lZ3 Place of Disposition K� 4fz� ILJ address/ W Cl)CC (section) 4:0,number) (grave number) 8 Name of Sexton or Person in Charge f premises /pase print/ W Signature Title rer K DOH-1555(07/18)p 1 of 2 7.1 16 0 "t 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#