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Harrison, Jay Walter
, NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jay Walter Harrison Male Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2024 63 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Thurman Town Street Address South Johnsburg Road,Thurman Town, New York 12885 p Manner of Death El Natural Cause Accident 0 Homicide El Suicide ❑Undetermined ❑Pending VCircumstances Investigation WD Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Thurman District Number Register Number City,Town or Village 5659 10 Burial Date Cemetery,Crematory or Facility Name . 02/08/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation 0 EIRemovai Date Place Removed and/or and/or Held F- Hold Address CO 0 O. Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address 1 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 l` Remains are Shipped,If Other than Above % Address Q W O. I Permission is hereby granted to dispose of the human remins described above as indicated. Date Issued 02/07/2024 Registrar of Vital Statistics Cynthia X 7fyde(Electronically Signed) (signature) District Number 5659 Place Town Of Thurman I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W �a Date of Disposition a- 9.f �y Place of Disposition ,Ale i/it",,J, (r-epl h r-LS(address) W NCC of (section) (lot num r) (grave number)g Name of Sexton or Person in Charge of Premise 74Y/40,4✓) k??L Z �� (please print) W g '1 Signature ) iW fig'Title Io DOH-1555(07/18)p 1 of 2 S 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#