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Hall Sr., Alan J NEWYORKSTATEDEPARTMENTOFHEALTH Bureau of Vital Records Burial - Transit Permit �" Name First Middle Last Sex Alan J.Hall Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 03/16/2023 82 Years War or Dates f. Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 25 Oak Street,Warrensburg Town,New York 12885 p Manner of Death ❑X Natural Cause Accident Homicide Suicide illUndetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Suzanne Bergin DO Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 5 Burial Date Cemetery,Crematory or Facility Name 03/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F- Hold Address O a Date Point of Cl) Transportation p by Common Shipment Carrier Destination EI Disinterment Date Cemetery Address Reinterment 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 F.. Remains are Shipped,If Other than Above "a Address LC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/20/2023 Registrar of Vital Statistics Eame&a M Lloyd(ECectronica((ySigned) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition lh I/3 Place of DispositionILI 2 (address) W g LC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Prem. ^ L (please print) ` W 741 Signature - Title G � � 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#