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Dreyer, Charles W. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles W. Dreyer Male Date of Death Age If Veteran of U.S.Armed Forces, 02/01/2020 86 Years Waror Dates 1953-1957 F— Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 41 Devin Court,Queensbury Town, New York 12804 p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending UCircumstances Investigation WW Medical Certifier Name Title Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed F5657 ict Number Register Number City,Town or Village Queensbury 19 ❑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 f- usHold Address 0 Id. Date Point of N 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 IH Remains are Shipped,If Other than Above Address cc W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/03/2020 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (Signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 713170 Place of Disposition .�,. ✓ ` t7C;w W /address/ W N Q (section) (lot number/ (grave number) 0 Name of Sexton or Person in Charge of Premises tj 3J'"`tft Z /pl ase print/ W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 3,')9 Receipt Human remains of delivered on , 20 � � y Pine View Cemetery Representingg the-funeral home named on burial permit Official Funeral Directors Reg.or License# f'' '