Resnick, Brad NEW YORK STATE DEPARTMENT OF HEALT 7f 5 g
Vital Records Section Burial - Transit Permit
774 Name First Middle Last Sex
o Brad H Resnick Male
Ft Date of Death Age If Veteran of U.S. Armed Forces,
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August 8,2016 60 War or Dates
r' ' Place of Death Hospital, Institution or
City, Town or Village Glens Falls
Manner of Death
Street Address Glens Falls Hospital
Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined pi Pending
Circumstances Investigation
Medical Certifier Name Title
Gamal kblija,MD
Address
100 Park Street,Glens Falls,NY 12801
✓r Death Certificate Filed District N` i�y Register jVym�gr
{,, City, Town or Village (p [�/ j�f
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❑Burial Date Cemetery or Crematory
❑Entombment August 11,2016 Pine View Crematory
Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
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0 Date Point of
W ElTransportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
�/, Permit Issued to Registration Number
{'f+' Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
' Address
407 Bay Road,Queensbury, NY 12804
s.
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
--=% Address
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i Permission is hereby granted to dispose of the human remains des ribed b e a i Gated.
; � Date Issued (��/0�!/1.U/6 Registrar of Vital Statistics /2z��h1
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F F, District Number S6,0/ Place 6/e-r..o jG ,,uy
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 8 lip if(, Place of Disposition 7(6,11,.... C.�ef�
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tY (section) (lot number) (grave number)
pName of Sexton or Person in Char a of Premises �rir,{,�/' -*r`^r
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Signature a Title gUOi i`d -
(over)
DOH-1555(02/2004)