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Hoag, Jacob Robert
Lay NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jacob Robert Hoag Male Date of Death Age If Veteran of U.S.Armed Forces, 07/30/2023 31 Years War or Dates 1_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death I !Natural Cause Accident Homicide Suicide Undetermined Pending W f ' Circumstances Investigation WMedical Certifier Name Title p Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 371 Burial Date Cemetery,Crematory or Facility Name 08/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 Cl. Date Point of U)❑Transportation Shipment p by Common Carrier Destination ODisinterment 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 2 Address cr LU O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/07/2023 Registrar of Vital Statistics Megan Wolin(ECectronicaffy 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 g Z> Place of Disposition �„�L. Zyr (address) W (section) d,,Ilot number/ (grave number) S Name of Sexton or Person in Charge of PremisesL ft tPase print/ W Signature Title (ruyrn'�To./ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 . Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# +`