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Scherer, Terence J LF) j z3(4 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Terence J.Scherer Male Date of Death Age If Veteran of U.S.Armed Forces, 03/01/2024 70 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Stony Creek Station Hamlet Street Address 142 Dartmouth Road,Stony Creek Station Hamlet,New York 12878 Ili 0 Manner of Death ❑X Natural Cause Accident 0 Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Madison Zuis NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Stony Creek District Number Register Number City,Town or Village 5658 2 Burial Date Cemetery,Crematory or Facility Name 03/05/2024 Pine View Cemetery Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address 0 O. Date Point of U) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address O 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 H Remains are Shipped,If Other than Above Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/04/2024 Registrar of Vital Statistics Susan I7-(arrington(ECectronica((y Signed) (signature) District Number 5658 Place Town Of Stony Creek I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 311211 f 2N Place of Disposition 4 Z✓FCL) /letrA t2r4-- W 2 (address) W N IT (section) �/ (lot numb (grave number) 0 Name of Sexton or Person in Cha a of Premises t„,.hiL fF Z please print/ W Signature 7 �►— Title G ill► e DOH-1555(o7/t8)p 1 of 2 1 ) - ',-•:.r, .:) r: Public Health Law Sec. 4145(2b) 1 Receipt Human remains of - delivered on , 20 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#