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Tucker, Howard E Sr. Y '- 01 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Howard E.Tucker Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/15/2024 89 Years War or Dates i:: Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 1400 S Johnsburg Road,Johnsburg Town,New York 12843 LIJI p Manner of Death El Natural Cause Accident El Homicide El Suicide DU ndetermined r 7 Pending U Circumstances Investigation ILI Medical Certifier Name Title CI John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 7 Burial Date Cemetery,Crematory or Facility Name 02/20/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation 2 Removal Date Place Removed 17 Q_ and/or and/or Held N Hold Address 0 tL Date Point of (i) Transportation p by Common Shipment Carrier Destination EDisinterment 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 E. Remains are Shipped,If Other than Above 5 Address CC Ili Ct, Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2024 Registrar of Vital Statistics Jean 94 Comstock(E(ectronically 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 2 1x V24 Place of Disposition S ;,re;J ip Pi,tw,Jn 2 (address) '��•F'L+~ W N IX (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre ' s d r, L [. Z Cyr lase print) W Signature Title 10 . DOH-t555(07/18)p i of 2 Public Health Law Sec. 4145(2b) f*.. 7 Ci Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#