Baker, Andrew Matthew . -�,Q4, F
.NEWYORK STATE DEPARTMENT OF HEALTH
. Burial - Transit Permit
bureau 6TVifal Records
Name First Middle Last Sex
Andrew Matthew Baker Male
Date of Death Age If Veteran of,U.S.Armed Forces,.
12/02/2022 8 Days War or Dates'-.>_,--
Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death Natural Cause Accident 1:1Homicide Suicide ❑Undetermined Pending
W n,a
U Circumstances Investigation'.
QW Medical Certifier Name Title
- Rehman Chowdhry MD
s; Address
` 43 New Scotland Ave,'Albany,New York 12208
Death Certificafe Filed City Of Albany District Number Register Number
City,Town or Village 0101" 2820
Burial Date Cemetery,Crematory or Facility Name
12/06/2022 Pine View Crematory
Entombment Address -
rZ;lCremation Queensbury Town-,New York
Donation
Z Removal Date Place Removed
O and/or and/or Held y `
'
V)N Hold Address
_
O
(- Date Point of
(n Transportation
p by Common Shipment
Carrier Destination
Disinterment. Date Cemetery Address
❑Reihterment Date Cemetery Address
/ Permit Issued to, Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
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196 Main S.,t,S.S:Glens Falls,New York 12803
Name of;Furieral Firm Making Disposition orto Whom
_ l ;=Remains are Shipped,If Otherthan Above
-.r - °Address
LLJ.
`Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/06/2022 Registrar of Vital Statistics Dan1elkSgillerpie(Electronuall Signed)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition IZ IL Place of Disposition
W
address/
W
cr (section) ((otncumber) (grave number)
aName of Sexton or Person in Charge o Premises Cf
Z (plea pr/ntf
W Signature Title
DOH-1555(o7/18)p 1 of 2
010 .
Public Health Law Sec. 4145(2b)
Receipt
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P � .
Human remains of delivered on 720
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Pine View Cemetery Representing the funeraal home named on burial permit
Official I! Funeral Directors Reg!or License#
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