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Daniels, Brian e 11 3g1 NEW YORK STATE DEPARTMENT OF HEALTH ,. Vital Records Section Burial - Transit Permit ia' Name First Middle Last Sex Brian Michael Daniels Male PI Date of Death Age If Veteran of U.S.Armed Forces, 05/09/2018 55 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined Pending Circumstances Investigation - Medical Certifier Name Title t. Suzanne Blood MD Address 152 Sherman Ave,Queensbury Town,New York 12801 f_: Death Certificate Filed District Number Register Number g.vs City, Town or Village Queensbury 5657 60 ❑Burial Date Cemetery or Crematory 05/11/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold 61 Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address i Li 'v Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 -T Address • 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped, If Other than Above • Address te U4 �, Permission is hereby granted to dispose of the human remains described above as indicated. • Date Issued 05/11/2018 Registrar of Vital Statistics Caroline.7fBar6er(E(ectronicattySigned) (signature) • District Number 5657 Place Queensbury, New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z tip Date of Disposition rllitlid Place of Disposition rkt .,4.,_ (address) tii 0. C4 (section) (lot umber) I (grave number) pName of Sexton or Person in Charge of Premises M- (peas print) tf Signature21 ..1- Title (*flit (over) DOH-1555 (02/2004)