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Karl, David Wayne • NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Wayne Karl Male Date of Death Age If Veteran of U.S.Armed Forces, 03/20/2023 70 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 105 Lawrence Street,Glens Falls,New York 12801 1p Manner of Death X❑Natural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 157 Burial Date Cemetery,Crematory or Facility Name 03/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ N Hold Address O a Date Point of U)❑Transportation $ by Common Shipment Carrier Destination DisintermentDate 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 Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/23/2023 Registrar of Vital Statistics Megan Wolin(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: Date of Disposition 3—K7-2 77 3 Place of Disposition ,Jr Vl CI4*j s-10111 - 2 (address) W CC N (section) (lot num r) (grave number) SName of Sexton or Person in Charge of Premises ' 1 4f e9,,) Z (please print) W Signature (� i%I/ " Title arr'r /— DOH-1555(07/18)p 1 of 2 • n33 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#