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Rheel, David G� NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit • Name First Middle Last Sex 71 David J. Rheel Male Date of Death Age If Veteran of U.S. Armed Forces, 1. 05/27/2018 75 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide El❑ Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Nawed Siddiqui MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 263 .El Burial Date Cemetery or Crematory 06/01/2018 Pine View Crematory ❑Entombment Address it®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held and/or Address Hold iaa Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address El 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 Other than Above Address at • Permission is hereby granted to dispose of the human remains described above as indicated. Rivp Date Issued 05/29/2018 Registrar of Vital Statistics cRg6ertA 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: Date of Disposition 614 IIi Place of Disposition (address) (section) A(lot numb (grave number) Name of Sexton or Person in Charge of P emises a se print) • Signature Title (p/ 1 +litig& (over) DOH-1555 (02/2004)