Hadden, Joshua NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
N• ame First Middle Last Sex
Joshua D. HADDEN Male
D• ate of Death Age If Veteran of U.S. Armed Forces,
1 1 /1 1 /2 01 7 36 War or Dates no
Place of Death Hospital, Institution or
City, TornetAkrx Glens Falls Street Address Glens Falls Hospital
Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ®Pending
Circumstances Investigation
Medical Certifier Name Title
Terry Comeau Coroner
`t Address
1340 State Route 9, Lake George, NY 12845
rk Death Certificate Filed District Number Register tuber
City, T5PritPkiliiiwy (,1 c nG Pall G c601 l
0 Burial Date Cemetery or Crematory
11 /14/2017 Pine View Crematory
❑Entombment Address
!I Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
_. and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
rs Carrier
4.4
❑Disinterment Date Cemetery Address
Date CemeteryAddress
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 0021 1
Address
24 Church St. , Lake Luzerne, NY 12846
1-k Name of Funeral Firm Making Disposition or to Whom
t41Remains are Shipped, If Other than Above
=T Address
' Permission is hereby granted to dispose of the human remains described a�q_vee i dicated.
Date Issued //`iy 20/7 Registrar of Vital Statistics /� L•���c Li,..
fti (signature)
• District Number �(o/ Place '4(,,J - 1, A 1Y
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1,I J cin Place of Disposition 1,�11--' l� z,....,
(address)
F
.f' (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises �', S7t'+,fr
tea (pll4ase print)
;
di
Signature 4l Title
i(AL'iv/1i-70/..
(over)
DOH-1555 (02/2004)