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Baker, Michael P Sr. ,--- -7 I ( N EW YORK STATE DEPARTMENT OF HEALTH 0 Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Michael P Baker Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 08/31/2023 85 Years War or Dates Army i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death 0 Natural Cause ❑Accident Homicide Suicide Undetermined Pending U Circumstances Investigation QW Medical Certifier Name Title Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number • City,Town or Village 5601 413 Burial Date Cemetery,Crematory or Facility Name ..' 09/02/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed csop and/or and/or Held N Hold Address 0 a Date Point of (/) Transportation a by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Service 01444 Address 94 Saratoga Ave,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom l- Remains are Shipped,If Other than Above a Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/01/2023 Registrar of Vital Statistics Megan No(in(ECectronicaCTySigned) (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: I— ILI Z Date of Disposition Z-ZvZ3 Place of Disposition e r)e t1vre,,J C,-, -4 C 2 (address) W CO 0 (section) (lot number) (grave number) O Name of Sexton or Person in Cha of Pr ' Ra ,) ' JQ Z VId (p/eas print W 4.--- Signature ` �‘ Title ©re„--. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of = delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#