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Bromley, Harry 1 f r -t NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Harry John Bromley Male Date of Death Age If Veteran of U.S.Armed Forces, , 12/16/2017 73 Years War or Dates 1964-1968 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident Homicide Suicide Undetermined Pending Circumstances Investigation ,... Medical Certifier Name Title ' Gwendolyn Morris-Dickinson PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 646 Date Cemetery y or Crematory 12/21/2017 Pine View Crematory 0 Entombment Address — ®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination „< Carrier Disinterment Date Cemetery Address 1 f Q Reinterment Date Cemetery Address x. Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom . Remains are Shipped, If Other than Above Address l° • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/18/2017 Registrar of Vital Statistics Rn6erta Curtis ErectronicarrySigned (signature) . District Number 5601 Place Glens Falls, New York �-- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i, Date of Disposition /2/2 i//7 Place of Disposition r �L v i` G/C2Yr4^` fy 1.. J / (address)/ t i (section) t (l t number) (grave number) F. Name of Sext of P rson in Charge of Premises �J r 4-41�� r a ` (please print) Signature Title L -rem ��r- (over) DOH-1555 (02/2004)