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Deffenbach, Eric Andrew 'COY � iz� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records , Name First Middle Last Sex Eric Andrew Deffenbach Male Date of Death Age If Veteran of U.S.Armed Forces, 02/01/2024 58 Years War or Dates i Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address Haynes House of Hope pManner of Death Z Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation LU• Medical Certifier Name Title CI Suzanne Bergin DO Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 6 Burial Date Cemetery,Crematory or Facility Name 02/06/2024 Pine View Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation Z Date Place Removed Q Removal and/or and/or Held F_- Hold Address N 0 L1 Date Point of 0)❑Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address n Reinterment 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 F- Remains are Shipped,If Other than Above N Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/05/2024 Registrar of Vital Statistics Jenny Linda M Martecre(Electronically Signed) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition 216 j2q Place of Disposition •Fli. vrnJ lei t1V10..- . 2 (address) LU (section)LA IX �� (lot number) (grave number) 2 Name of Sexton or Person in Charge of Premises `n °'� L._ 1a "�It W a /ease print) Signature a4'r Title I W(m DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) U 1 " Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit 1 Official Funeral Directors Reg.or License#