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Fleming, Adam Christopher 97 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Adam Christopher Fleming Male Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2023 41 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 22 Harlem Street Apt. 1, Glens Falls, New York 12801 pManner of Death El Natural Cause ❑Accident Ei Homicide ESuicide Undetermined El Pending U Circumstances Investigation u) 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 402 Burial Date Cemetery,Crematory or Facility Name 08/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of U)❑Transportation p by Common Shipment 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 H Remains are Shipped,If Other than Above 2 Address LC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/29/2023 Registrar of Vital Statistics Megan Not-in(E(ectronicalTy 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 ",30.-20l3 Place of Disposition Pr/J e ✓, Cperi k-/r IJJ (addrJ W Q (section) , q (lot number) (grave number) 8 Name of Sexton or Person in Ch a of P ises h i�74 /i/G�Cj' W (please print/ Signature Title etereiti" DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains o delivered on , `t , 20 2. '} 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#