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Bradley, Elton NEW YORK STATE DEPARTMENT OF HEALTH' ' '" #(ill Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elton Arthur Bradley Male Date of Death Age. If Veteran of U.S. Armed Forces, A May 20, 2018 81 War or Dates Place of Death Hospital, Institution or • City, Town or Village Fort Edward Street Address 42 Gates Avenue Manner of Death 0 Natural Cause 0 Accident Homicide Suicide Undetermined Pending Circumstances Investigation U Medical Certifier Name Title Ashley Watson, ,07i.9, Address Greenwich Family Health g Death Certificate Filed District Number Register tuber ,' City, Town or Village 5 17 55 ", ❑Burial Date Cemetery or Crematory May 23, 2018 Pine View Crematorium Entombment Address ., ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held °= and/or Address ., Hold Union Cemetery Date Point of Transportation Shipment ca by Common Destination Carrier ,` Date Cemetery Address Disinterment E : V ElReinterment Date Cemetery Address Tat � -,-• = Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address : . Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 ''K Name of Funeral Firm Making Disposition or to Whom -` Remains are Shipped, If Other than Above Address trf Wa. Permission is hereby granted to dispose of the human r ins describe o indicated. ',: Date Issued 5-613-0M Registrar of Vital Statistics (5'155 (signature) District Number Place r�� Q6 �1721 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 05/23/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) th t (section) /li(lot numberZ (grave number) itki Name of Sexton or Person in Charge of Premises E'� ilk „Ai (Tease print) Signature Title efifmtilM (over) DOH-1555 (02/2004)