Brayman, James 17
t r I
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James Donald Brayman Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 5, 2016 88 War or Dates US NAVY
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY )Z O I Street Address Glens Falls Hospital
ig Manner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
g Medical Certifier Name Title
0. David Foote MD
Address
:••:: Hudson Falls,NY 1, 3.9
Death Certificate Filed District Number Register
umber
Zpcl
City, Town or Village Glens Falls, NY ) �4/`
• ❑Burial Date Cemetery or Crematory
January 7, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
O 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 Regan& Denny Funeral Home 01444
Address
94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
''' Remains are Shipped, If Other than Above
Address
Permission is he eby granted to dispose of the human re�ains de ribed abov as indicat
Date Issued ^1 0 0 Registrar of Vital Statistics , LEel.-/_--/- _
(signature-2 )
District Number ) Placefu‘ O i
1
I certify that the remains of the decedent identified above were di osed of in accordance ith this permit on:
W Date of Disposition /$-/(p Place of Disposition 2r9-2Q, 1) L,.d (-ce, i q4,/'v
2 (address) /
W
co
d' (section) fiot number) (grave number)
0
p Name of Sexton or er on in Charge of Premises ..)ic I;G,✓I �►ytctil/h€
Z / (please print)
W Signature t f/ Title C-re-nc4 o/'
(over)
DOH-1555(02/2004)