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Kirkpatrick, David P. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Male David P.Kirkpatrick Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2020 65 Years Waror Dates 1971-1973 II... Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 111 Manner of Death Undetermined Pending Ip ©Natural Cause Accident Homicide Suicide Circumstances Investigation V Title Q Medical Certifier Name Jennifer Donovan DO Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 40 Burial Date Cemetery,Crematory or Facility Name 01/23/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation Date Place Removed ZO Removal and/or Held t- and/or CO Hold Address Point of N Transportation Date Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address ElReinterment 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 c W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/23/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: j H Z Date of Disposition /)Z3 170 Place of Disposition .., 60r1, _ W (address) Ill N (section) (lot number/ (grave number) 0 Name of Sexton or Person in Charge of Premises Z r(P print) ring W Signature Title Ir C�'^ ./ DOH-1555(07/18)p t of z I Public Health Law Sec. 4145(2b) _ 4 01-3 2 7-1, i Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i i