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Scidmore, Gary N . 4 —)3 tl NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records ' Name First Middle Last Sex Gary N.Scidmore Male Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2023 66 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Horicon Town Street Address 7805 New York 8 Route, Horicon Town, New York 12815 p Manner of Death ❑X Natural Cause EAccident Homicide ESuicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 5 Burial Date Cemetery,Crematory or Facility Name 09/12/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held H Hold Address 0 Q. Date Point of Cl) Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom l— Remains are Shipped,If Other than Above 5 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/11/2023 Registrar of Vital Statistics 7(rstaL Wood(ECectronicaCCySigned) (signature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition �I►3 I Z3 Place of Disposition 2 (address) W NCC (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises I It (p se print) / LU Signature Title ` �Cr/ DOH-1555(07/18)p 1 of 2 Ji 233 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# . . 4 -)3 11 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gary N.Scidmore Male Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2023 66 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Horicon Town Street Address 7805 New York 8 Route, Horicon Town, New York 12815 uJ Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 5 Burial Date Cemetery,Crematory or Facility Name 09/12/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held NH Hold Address 0 O. Date Point of co Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC LU O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/11/2023 Registrar of Vital Statistics 7Crista£Wood(Electronica1TySigned) (signature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition I I l,3 I Z3 Place of Disposition '�,ti(,L 2 (address) W CC N (section) A (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises tti"l� ( se print) Z !lJJJJ r W Signature Title ` r"Ii �� DOH-1555(07/18)p 1 of 2 . '4 11. 7233 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#