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Lancette, Richard N. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard N. Lancette [Male Date of Death Age If Veteran of U.S.Armed Forces, 02/25/2020 23 Years War or Dates II.— Place of Death Hospital,Institution or W Glens Falls Hospital City,Town or Village Glens Falls Street Address p Manner of Death Natural Cause Accident Homicide Suicide Undetermined ©Pending W Circumstances Investigation U W Medical Certifier Name Title Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 96 ❑Burial Date Cemetery,Crematory or Facility Name 03/02/2020 Pine View Crematory Entombment Address aCremation Queensbury Town,New York ❑Donation Date Place Removed ZO Removal and/or and/or Held N Hold Address IL Date Point of N Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 orto Whom Remains are Shipped,If Otherthan Above Address Cr W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/27/2020 Registrar of Vital Statistics Robert Andrew 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: 1 W Date of Disposition 3 2 1 1 1� a Place of Disposition � (address) 2 W Cr /section) (lot number) r (grave number) P.4 it 0 Name of Sexton or Person in Charge of/Premises \ a L.✓t (P -print) Z W Signature Title L. DOH-1555 L (07/18)p 1 of 2 Public Health Law Sec. 4145(2b) � 1.i 3 7 9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# s'