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Slupik. Christian Joachim
:5 IT y sm NEW YORK STATE DEPARTMENT OF HEALTH l - Transit Permit Bureau of Vital Records Burial Name First Middle Last Sex Christian Joachim Slupik Male Date of Death Age If Veteran of U.S.Armed Forces, 05/26/2023 61 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Chester Town Warren Street Address 4229 Glendale Road,Chester Town Warren,New York 12860 W Manner of Death Undetermined Pending C Natural Cause Accident Homicide Suicide W U Circumstances Investigation W Medical Certifier Name Title CI Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 8 Burial Date Cemetery,Crematory or Facility Name 05/30/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZZ❑Removal Date Place Removed and/or and/or Held h- Hold Address N 0 Date Point of N Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above E Address LC I1J a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/30/2023 Registrar of Vital Statistics Mindy Conway(Ehctronica1Ty Signed) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: L— Z Date of Disposition -I/3c/?3 Place of Disposition 17.,U. O- . W (address) W N CC (section) (lot number) (grave number) AokNeL.0Name of Sexton or Person in Charge of Premises Z (please prIM7C4 W Signature Title �°�W�r1 DOH-1555(07/18)p 1 of 2 r) 1.7OO2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , Pine View Cemetery Representing the funeral home named pn burial permit Official Funeral Directors Reg.or License#,' r,;