Dunn Jr., Dusty NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section i Burial - Transit Permit
g Name First Middle Last Sex
KO Dusty L.Dunn,Jr. Male
. Date of Death Age If Veteran of U.S. Armed Forces,
9/29/2018 26 War or Dates n!a
,tt, Place of Death Hospital, Institut l or
City, Town or Village Day I Stieet Address
orth Shore Road
Manner of Death❑Natural Cause ®Acc -i4'nt Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
• Medical Certifier Name Title
Susan Hayes-Masa Coroner
Address
rai 40 McMaster St., Ballston Spa, NY 12020
Ire
It Death Certificate Filed Da District Number �� .� Register Number
ii
City, Town or Village y
LIBurial Date Cemetery or Crematory
10/4/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury,NY
Date Place Removed
I❑Removal and/or Held
and/or
Address
Hold
Date Point of
• Q Transportation Shipment
by Common Destination
kei Carrier
ke
Q Disinterment Date Cemetery Address
ift:3,4
14 0Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
• Address
24 Church St.,Lake Luzerne,NY 12846
: Name of Funeral Firm Making Disposition or to Whom
.• Remains are Shipped, If Other than Above
Address
3zli a Permission is hereby granted to dispose of the human regains described ab ye as indicated.
R
Date Issued 10/1/2018 Registrar of Vital Statistics \kN ,
(signature)
District Number Place Town of Day
tv
it I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l Date of Disposition /O-S—is Place of Disposition i"Ae, IA 'i C)kiwi)4.c)f
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises J e .p'tt'y %( ;rt. s
(please print)
Signature ' Title Cie
(over)
DOH-1555 (02/2004)