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Scheib, Hardy Isreal y � .� 3 NEW YORK STATE DEPARTMENT OF HEALTH iTy r Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Hardy Isreal Scheib Male Date of Death Age If Veteran of U.S.Armed Forces, 08/25/2023 84 Years War or Dates 1— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death I:I Natural Cause Accident Homicide Suicide Undetermined El Pending V Circumstances Investigation aLU Medical Certifier Name Title Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 403 Burial Date Cemetery,Crematory or Facility Name 08/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York EjDonation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 a Date Point of to❑Transportation 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 I— Remains are Shipped,If Other than Above a Address II LU 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 Wolin(ECectronicalTySigned) (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 ZQZ7Place of Disposition 1 AJ e J,,p C 4 LU 2 (address) W N Et (section) (lot number) (grave number) qq g Name of Sexton or Person in Charge of Premises t `r'l i!„1 b (,keel Z (please print) W Signature ..ss 7. Title c7 Ce.74 5 r DOH-1555 l07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) Receipt Human remains of I, i i ` ,1" (-) delivered on ' ? , 20 ''. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,._ .,{,()