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Holcomb, Floyd Leslie Jr. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Floyd Leslie Holcomb Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/18/2024 69 Years War or Dates i.,_ Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 203 Tripp Lake Road,Warrensburg Town,New York 12885 p Manner of Death Z Natural Cause ❑Accident Ej Homicide Suicide Undetermined ❑Pending W U Circumstances Investigation CI Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 2 RBurial Date Cemetery,Crematory or Facility Name 02/20/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,Warren,New York Donation 0❑Removal Date Place Removed H and/or and/or Held - Hold Address 0 tl Date Point of CO OTransportation Ea- by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address l l Reinterment Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom p-. Remains are Shipped,If Other than Above 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/20/2024 Registrar of Vital Statistics (Pamela 9t(GCoyd(ECectronicallySigned) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition Z 1211261 Place of Disposition {�lt,i;✓yi� �% i ill Tri2Tv _ (address) W V) O (section) / (lot number (grave number) 0 Name of Sexton or Person in Charge of Pye ' s L Z please print) W Signature Title p(..'Inc_ DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#