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Skorput, Michael Elbert NEW YORKSTATE DEPARTMENT OF HEALTH • Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Michael Elbert Skorput Male Date of Death Age If Veteran of US.Armed Forces, 02/10/2024 74 Years War or Dates Vietnam H. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital O Manner of Death ❑X Natural Cause Accident Homicide ESuicide nUndetermined Fl Pending W Circumstances Investigation O Medical Certifier Name Title Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 89 EBurial Date Cemetery,Crematory or Facility Name 02/13/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation toEland/or Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 0. Date Point of U)ETransportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment 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 1— Remains are Shipped,If Other than Above 2 Address R W O Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/13/2024 Registrar of Vital Statistics Megan Wo(in(E(ectronica1Ty 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: I— W Date of Disposition Zlic.J IN Place of Disposition F• �;.G u (/I i� WjrT�,l.— 2 (address/ W Cl) CC (section) A (lot number) (grave number) SName of Sexton or Person in Charge of Premises r 6+ tt z (p/ se print/ W Signature Title � iQ1° . DOH-1555107/18)p 1 of 2 t , ' 7;C 6 Public Health Law Sec. 4145(2b) '� Receipt Human remains of I delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#