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Smith Sr., Christopher Lewis ` 4 3gL NEW YORK STATE DEPARTMENT OF HEALTH ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Christopher Lewis Smith Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 04/25/2023 51 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address 226 Warren Street,Glens Falls,New York 12801 • Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide FlUndetermined Pending W Circumstances Investigation WG• Medical Certifier Name Title 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 216 RBurial Date Cemetery,Crematory or Facility Name 04/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation ❑Removal Date Place Removed and/or and/or Held f Hold Address 0 O. Date Point of W ETransportation p by Common Shipment Carrier Destination Disinterment 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 Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/27/2023 Registrar of Vital Statistics Megan Wolin(ECectronicaCCy 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: Z � Date of Disposition LAZ/-ZZ3 Place of Disposition Yjl frJ e Li, et,..) C(-e-in,40 ru 2 (address) NJ CC N (section) (lot n ber) (grave number) gName of Sexton or Person in Charge of�-emise 1�Y/�'ir�/) (9f.� Z / (please print) W Signature i 1 i Title O Pt'TQ- DOH-1555 l07/18)p 1 of 2 (^ wa 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#