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Maurals, Gerard III NEW YORK STATE DEPARTMENT OF HEALiF;Vital Records Section Burial - Transit Permit Name First Middle Last Sex Gerard G.Maurais Male Date of Death Age If Veteran of U.S. Armed Forces, 12/03/2017 89 Years War or Dates WWII Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitati Manner of Death© Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Gwendolyn Morris-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 620 ❑Burial Date Cemetery or Crematory 12/11/2017 Pine View Crematory El Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address sue. 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 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2017 Registrar of Vital Statistics &fiertACurtis Ectronicaffy 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 /z/ ( t/'place of Disposition 'hM (address) (section) f7 (lot number (grave number) Name of Sexton or Person in Charge of Premi es c �N e print) Signature (pl as Title (kiltt'TIL (over) DOH-1555 (02/2004) I