Brennan, Ernest Paul NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ernest Paul Brennan Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/23/2019 50 Years War or Dates 1988-1994
Place of Death Hospital,Institution or
WCity,Town or Village Northumberland Town Street Address 86 Pettis Road,Northumberland Town, New York 12831
`p Manner of Death Natural Cause Accident Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C3 Susan Hayes-Masa Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Dis Death Certificate Filed trict Number Register Number
City,Town or Village Northumberland Town 4563 14
❑Burial Date Cemetery,Crematory or Facility Name
11/27/2019 Pine View Crematory
Entombment Address
X Cremation Queensbury,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
~N Hold Address
O
a Date Point of
NElTransportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition orto Whom
Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/27/2019 Registrar of Vital Statistics DDenzre D-furpvy(EkctrankaY S#aed)
(signature)
District Number 4563 Place Northumberland Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
W Date of Disposition )J W IV/ Place of Disposition 7`rwc �;
address/
2
W
N (section) (lot number) (grave number)
� _ I
0 Name of Sexton or Person in Charge of Prelnises
Z (please print)
W
Signature 7s fs�!�� f Title C
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) '` 111.
Receipt
Human remains of �delivered on , 20
Pine View Cemetery Representing the funeral home named qn hprial permit i
Official Funeral Directors Ree.,ar License# ' '
1