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Deuel, Kevin K. ti11 N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kevin K.Deuel Male Date of Death Age If Veteran of U.S.Armed Forces, 02/01/2020 60 Years War or Dates �.. Place of Death Hospital,Institution or Z City,Town or Village Corinth Village Street Address 216 Ash Street,Corinth Village, New York 12822 W p Mannerof Death ©Natural Cause Accident H 1:1omicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title 0 Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 05 ❑Burial Date Cemetery,Crematory or Facility Name 02/03/2020 Pine View Crematory Entombment Address iCremation Queensbury Town,New York ❑Donation 0 Removal Date Place Removed and/or and/or Held E- Hold Address N O (L Date Point of U) 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 or to Whom Remains are Shipped,If Otherthan Above Address cc W o' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/03/2020 Registrar of Vital Statistics Rose E Farr(Electronically Signed) (signature/ District Number 4553 Place Corinth, 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 213110 Place of Disposition f Ckw — LU (address) W N (section) (lot number) (grave number) X 0 Name of Sexton or Person in Charge of Pre ises r ONn1l� (p ase print) LU Signature Title c DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 13 3 0 E" Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#