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Merrithew, Steven J.
�17 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Steven J.Merrithew I Male Date of Death Age If Veteran of U.S.Armed Forces, 01/04/2020 65 Years Waror Dates 1972-1978 F Place of Death Hospital,Institution or WCity,Town or Village Hadley Town Street Address 3871 North Shore Road, Hadley Town, New York 12835 p Mannerof Death Natural Cause Accident Homicide ©Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 1 Burial Date Cemetery,Crematory or Facility Name 01/06/2020 Pine View Crematory Entombment Address 1 Cremation Queensbury Town, New York ❑Donation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address N O G. Date Point of N ❑Transportation Shipment Q by Common Carrier Destination EjDisinterment Date Cemetery Address JE]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 or to Whom �.. Remains are Shipped,If Other than Above Address W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/06/2020 Registrar of Vital Statistics Pauline G Smead(Electronically Signed) (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition 1 11176 Place of Disposition ;-0 sk.. - (address) W (section) / (lot number/ (grave number) 0 [/ Lc Name of Sexton or Person in Charge of Premises '� Z (p ase print) W Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013211 Receipt Human remains of /.:delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# -`,