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Hipp, Richard George �` . 03 NEW YORK STATE DEPARTMENT OF HEALTH '. Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard George Hipp Male Date of Death Age If Veteran of U.S.Armed Forces, 08/30/2023 83 Years War or Dates 1965-1967 F,,, Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 103 Tee Hill Road,Queensbury Town, New York 12804 O Manner of Death ❑X Natural Cause IllAccident 0Homicide ESuicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 135 Burial Date Cemetery,Crematory or Facility Name 08/31/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 G. Date Point of U)OTransportation Shipment p by Common Carrier Destination IDDisinterment 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 1— Remains are Shipped,If Other than Above 2 Address LC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/31/2023 Registrar of Vital Statistics Caroline Jfilcfegarde Barber(ECectronicaCCySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— ▪ Date of Disposition /-' 0Z3 Place of Disposition O;,1 e it (Ie4ri c 2 (address) W CCCC (section) (lotn ber) (grave number) 8 Name of Sexton or Person in Charge of P mise K/4y/� Wo/v5 i z / (please print/ W Signature t / Title Oe..P1-4"-- 6 DOH-1555(07/18)p 1 of 2 r W y 1 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#