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Martindale, Michael W, Jr.
..(11---F\`) # Z NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Perm t Bureau of Vital Records Name First Middle Last Sex Michael W.Martindale Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 01/01/2024 41 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Plattsburgh Street Address Champlain Valley Physicians Hospital Medical Ctr pManner of Death ❑X Natural Cause DAccident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Cl Nicholas Aunchman MD Address 75 Beekman St,Plattsburgh,New York 12901 Death Certificate Filed City Of Plattsburgh District Number Register Number City,Town or Village 0901 8 ElBurial Date Cemetery,Crematory or Facility Name 01/05/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation g❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of (I)DTransportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment 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 .- Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/05/2024 Registrar of Vital Statistics Sylvia Gad cParrotte(Electronically Signed) (signature) District Number 0901 Place City Of Plattsburgh I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- � WDate of Disposition / il- '-zzz 7 Place of Disposition ,,)Q ii7 ? (tY.-yy1A„ ,.-� 2 (address) W CCCC (section) (lot n mber) (grave number) gName of Sexton or Person in Charge of Prem ---- 140-/feiLi t cJE5tl Z (please print) a ) Title Oe�iv W Signature <. 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#