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Hayes, John F t_. LF # 5),() NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John F.Hayes Male Date of Death Age If Veteran of U.S.Armed Forces, 10/29/2023 78 Years War or Dates Vietnam F.. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital 111 ▪ Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation 0LU Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 504 Burial Date Cemetery,Crematory or Facility Name 10/31/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of CO ElTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address riReinterment 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 H Remains are Shipped,If Other than Above S Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/31/2023 Registrar of Vital Statistics Megan Wolin(ECectronica1TySigned) (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— Z Date of Disposition Il/z 173 Place of Disposition -�iT,6.,,,-<,,,/ CP it N_ 2 (address) W CC N (section) (tot number) (grave number) SName of Sexton or Person in Chafe of Premises ;- l ,rtf Z / / ease print) W Signature /� Title C 1 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#