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Hopkins, Gerald E. Sr. V DEPARTMENT HEALTH - 1...._ NEW YORKSTATE DE Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Gerald E.Hopkins Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/17/2024 72 Years War or Dates pt Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death IZI Natural Cause EAccident ❑Homicide 0Suicide Undetermined ri Pending W Circumstances Investigation W Medical Certifier Name Title O Wendy Steinhacker PA Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 8 Burial Date Cemetery,Crematory or Facility Name 02/20/2024 Pine View Crematory Entombment _ Address p,", ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 EL Date Point of (/)ETransportation Shipment C) by Common Carrier Destination Disinterment Date Cemetery Address Reinterment 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 F- Remains are Shipped,If Other than Above Address CC D. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/19/2024 Registrar of Vital Statistics Jean M Comstock(Electronically Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- W Date of Disposition 2121124 Place of Disposition„(v;f, tom!1,0 ( mTeep,,_ 2.. (address) LU Nix (section) A(lot number) (grave number) O Name of Sexton or Person in Charg f Premises 7 rl � A Z (ple a print/ W Signature Title ` rig' DOH-1555(07/18)p 1 of 2 ^ • ♦ S.p 70 F.;‘,‘ Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home natued on burial permit Official Funeral Directors Reg.or License#