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Putnam, Richard John NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records .., Name First Middle Last Sex Richard John Putnam Male Date of Death Age If Veteran of U.S.Armed Forces, 02/03/2024 85 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number ,Town or Village Cie 5601 73 Burial Date Cemetery,Crematory or Facility Name 02/06/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZZ 0Removal Date Place Removed and/or and/or Held F-N Hold Address 0 4. Date Point of (p❑Transportation Shipment Q by Common Carrier Destination EiDisinterment Date Cemetery Address OReinterment 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 H Remains are Shipped,If Other than Above 2 Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2024 Registrar of Vital Statistics Megan Wolin(E(ectronica1y Signed) (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: II— I Date of Disposition 211 tZ 4 Place of Disposition T TNfi,T 6C40147fh2 it-- 2 (address) ILl NCC (section) (!at number) (grave number) g Name of Sexton or Person in Charge of P 'ses i N A.. iN (piltse print) / W Signature Title Gw'sn DOH-1555(07/18)p 1 of 2 j • -+ =* I Cy ) , Public Health Law Sec. 4145(2b) Receipt Pam-(A'APD Human remains of — ' : delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#