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Baran, Raymond J. 50 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Raymond J. Baran Male Date of Death Age If Veteran of U.S.Armed Forces, 11/29/2019 71 Years WarorDates 1968-1970 F Place of Death Hospital,Institution or WCity,Town or Village Moreau Town Street Address 206 Ferry Boulevard, Moreau Town, New York 12803 p Manner of Death ©Natural Cause Accident Homicide Suicide El Undetermined Pending 0 Circumstances Investigation LL1QW Medical Certifier Name Title Susan Hayes-Masa Coroner Address 40 McMaster Street, Ballston Spa, New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 56 Burial Date Cemetery,Crematory or Facility Name 12/03/2019 Pine Vier Crematory Entombment Address Cremation Queensbury Town, New York Donation 0 Removal Date Place Removed and/or and/or Held ~to Hold Address O IL Date Point of CO) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition orto 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 12/02/2019 Registrar of Vital Statistics L6umMcrife(E1a1rcncFJ1y9gW (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ ! fD Z Date of Disposition IZ�►�� Place of Disposition ,.,� r." W (address) tll N Q (section) (lot number) (grave number/ 0 Name of Sexton or Person in Charge of Premises < f � Z /p/e se print/ W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013126 Receipt Human remains of `J delivered on ,, , 20/ Pine View Cemetery Rept senting the funeral home named on burial permit Official Funeral Directors Reg.or License# f