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Ordway, Michael P
it 2 NEW YORK STATE DEPARTMENT OF HEALTH �' Bureau of Vital Records Burial - Transit Perm Name First Middle Last Sex Michael P.Ordway Male Date of Death Age If Veteran of U.S.Armed Forces, 03/09/2024 67 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 14 Waldron Road,Johnsburg Town,New York 12853 Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide g W Circumstances Investigation W Medical Certifier Name Title Ryan Donnelly DO Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 13 Burial Date Cemetery,Crematory or Facility Name 03/12/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0 ElRemoval Date Place Removed and/or and/or Held Hold Address 0 CL Date Point of (/)IIITransportation Shipment Gl 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 1- 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 03/11/2024 Registrar of Vital Statistics lean Comstock(ECectronica1tySigned) (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- Z Date of Disposition 3I(Z IN Place of Disposition Psi ir.A.J (e/e/M1lapi-- W (address) W CC (section) (lot number) (grave number) p Name of Sexton or Person in Charge of Premis (r" L lit (p se print) W Signature Title r M� DOH-1555(07/18)p 1 of 2 • " 5a. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#