Loading...
Centerbar, Ernest George Jr. g 93NEW YORKSTATE DEPARTMENT OF HEALTH l Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ernest George Centerbar Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/19/2023 63 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 189 Rollies Road,Warrensburg Town, New York 12885 pManner of Death Z Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title 0 Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 17 Burial Date Cemetery,Crematory or Facility Name 11/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of (!)❑Transportation Shipment p by Common 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 1— Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/20/2023 Registrar of Vital Statistics Pamela 9lf£Coyd(ECectronicaltySigned) (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: Z W Date of Disposition //-ZZ-ZG7 j Place of Disposition (P � /`,�/e ;� ey ,v � 2 (address) W N (section) � (lot number) (grave number) gName of Sexton or Person in Charge of Pre ise ///a,-lb &/(�ci Z (please print) W Signature Title 6 e-e 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#