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Baker, Robert Richard Sr.
°V t NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle - Last Sex Robert Richard Baker Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 08/28/2023 60 Years War or Dates 1981-1984 ... Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 1 St.Paul's Drive 6F,Hudson Falls Village,New York 12839 ILJ p' Manner of Death E Natural Cause []Accident []Homicide []Suicide Undetermined []Pending I1J Circumstances ' 'Investigation W Medical Certifier Name Title Q William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 27 Burial Date Cemetery,Crematory or Facility Name ® 08/30/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held ! Hold Address 0 d. Date Point of N Transportation ES Common Shipment Carrier Destination O Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/30/2023 Registrar of Vital Statistics Cynthia (Banlin(Electronically Signed) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Zl1 Place of Disposition ft JoP J+e,4.) >Is (address) !tI CC N (section) (lot limber (grave number) 0 /t Name of Sexton or Person in Charge of P mises rein i,v%) f Z (please print) Signature �ysf Title v{�eS'Li-'h',- DOH-1555(07/18)p 1 of 2 Y • Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#