Brayton, Ralph Lee -V
NEW YORKSTATE DEPARTMENT OF HEALTH BUriai - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ralph Lee Brayton Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/24/2019 82 Years Waror Dates Unknown
IF— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
C1 Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Anthony Petracca MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 511
Burial Date Cemetery,Crematory or Facility Name
11/27/2019 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
z Removal Date Place Removed
O and/or and/or Held
H CO) Hold Address
O
IlL Date Point of
CO) Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Registration Number
Permit Issued to
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
Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/27/2019 Registrar of Vital Statistics RpAerr gndrewCurtu�!'lertronxaf Signed)(signature)
District Number 5601 Place Glens Falls, New York
I certify thatthe remains of the decedent identified above were disposed of in accordance with this permit on:
F
W Date of Disposition j%a Place of Disposition 17r
(address)
W
N (section) (lot number) (grave number)
IM
Name of Sexton o 1r Person in C arge of P mises r
(please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) s 013112
Receipt
Human remains of delivered on , 20
Pine View Cemetery Regr6senting the funeral home named on buj'al permit
Official Funeral Directors Reg.or License#