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Brouthers, Joseph F. �3 i NEW YORKSTATE DEPARTMENT OF HEALTH F Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph F. Brouthers Male Date of Death Age If Veteran of U.S.Armed Forces, 12/14/2019 78 Years War or Dates 1959-1978 Place of Death Hospital,Institution or WCity,Town or Village North River Hamlet Street Address 310 Harvey Road, North River Hamlet, New York 12856 p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title 0 Suzanne Bergin DO Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 50 ❑Burial Date Cemetery,Crematory or Facility Name 12/16/2019 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held P Hold Address to O IL Date Point of to ❑Transportation Shipment p by Common Carrier Destination Ej Disinterment Date Cemetery Address JE]Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake, New York 12842 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address I W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/16/2019 Registrar of Vital Statistics KdH66n C Lcrah(Eledro4c4lyS9W (signature/ District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 12 ff I Place of Disposition F'-V' t,rto... LL! /address/ 2 W N /section/ (lot numbe /grave number/ Q Name of Sexton or Person in Charge of Premiss �� R Z l n,� / (lease print) W Signature /////��� f Title 1 DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) - Receipt Human remains of delivered on , 20 F �r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# d