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Boos F. Brian
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Brian F.Boos Male Date of Death Age If Veteran of U.S.Armed Forces, 02/21/2020 56 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Wp Manner of Death © Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Abigail Macomber PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Glens Falls 5601 90 Burial Date Cemetery,Crematory or Facility Name 02/24/2020 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York Donation ZO ❑Removal Date Place Removed and/or and/or Held H to Hold Address O (L Date Point of to Transportation Shipment Q by Common p Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment I Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/24/2020 Registrar of Vital Statistics Wgbert,4ndrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ` ZW Date of Disposition Z zK LO Place of Disposition f � f iu.-- 2 (address) W CO) (section) (lot number) (grave number) w _4 O Name of Sexton or Person in Charge of Premises r0i�8 (pteJseprintl W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013 3 *3 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named gn b al permit Official Funeral Directors Reg.or License# ` :l a