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Tennant, John Leroy Q-11F) 5 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John LeRoy Tennant Male Date of Death Age If Veteran of U.S.Armed Forces, 11/02/2023 76 Years War or Dates 1965-1966 Place of Death Hospital,Institution or W City,Town or Village Warrensburg Town Street Address 2087 Schroon River Road,Warrensburg Town,New York 12885 O Manner of Death El Natural Cause Accident Homicide El Suicide Undetermined El Pending O Circumstances Investigation MI Medical Certifier Name Title 0 Tanya Finch NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 15 Burial Date Cemetery,Crematory or Facility Name 11/07/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address 0 O. Date Point of U) Transportation p by Common Shipment Carrier Destination ElDisinterment 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 • Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/06/2023 Registrar of Vital Statistics cPame&a MGCoyd(ECectronicaCCySigned) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition II ()7) Place of Disposition 1D 2'/JR/z6t.J CeF_MA1aR�da-� 2 (address/ W (I) (section) n (lot number) (grave number) Name of Sexton or Person in Charge of es - tovbAtN Z (pi se print) f W Signature Title l R'�f"��i I DOH-1555(07/18)p 1 of 2 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# It i. •z