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Bradway, Jesse 1 4730 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Jesse A. Bradway Male a Date of Death Age If Veteran of U.S. Armed Forces, October 3,2016 47 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital tit Manner of Death X Natural Cause Accident 1 I Homicide Suicide Undetermined Pending tri: Circumstances Investigation Ad Medical Certifier Name Title EGf; Timothy E.Murphy '-:.:1 Address Fto:: 52 Haveland Ave.,Glens Falls,NY 12801 i.I'' Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 ❑Burial Date Cemetery or Crematory El Entombment October 5,2016 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address H Hold N O Date Point of O. Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address : Permit Issued to Registration Number -: Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 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 I 0144 V l 16 Registrar of Vital Statistics v C&A4-v - (sig ture) • District Number 5 6 O 1 Place 6(. S To, `1 5 l t�L I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 'of b/IL Place of Disposition 420-1O1ew filly (n..., W (address) N O (section) ,,/// (lot number)f. (grave number) p• Name of Sexton or Person in Charge of Premises LSt,- A$N1a4 Z ( lease print) w Signature j .211 Title (tZeM t- (over) DOH-1555 (02/2004)