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Hubbard, Terry Nelson Sr
g. # 7 g Li NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Terry Nelson Hubbard Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 03/19/2024 71 Years War or Dates 1971-1975 i-. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 1p Manner of Death a Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Shahid Ahmed 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 162 EIBurial Date Cemetery,Crematory or Facility Name 03/21/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of U)❑Transportation Shipment p by Common Carrier Destination III Disinterment Date Cemetery Address 11 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 H Remains are Shipped,If Other than Above 2 Address R W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/21/2024 Registrar of Vital Statistics Megan Nolin(ECectronicallySigned) (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: Z W Date of Disposition 3141 24 Place of Disposition -17IN (4,6(.3 (AC 614INZTV--. 2 (address) W U)CC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises /A' eprinti2/( Aloili.... `�' 14 Z W Signature �� Title let �Q DOH-1555(07/18)p 1 of 2 •1 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# L