Bryant Jr, Edgar it
NEW YORK STATE DEPARTMENT OF HEALTH 3�
ll-
Vital Records Section
Burial - Transit Permit
•
Name First Middle Last Sex
Edgar G. Bryant Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 3, 2016 61 War or Dates
Place of Death Hospital, Institution or
(ilt City, Town or Village Street Address 2050 Coach Road
Manner of Death El Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined El❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Aqeel A. Gillani, M.D. Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number S-,5 6 Register Number
City, Town or Village /q
❑Burial Date Cemetery or Crematory
May 4, 2016 Pine View Crematory
El Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
• and/or Address
• Hold
lit Date Point of
O ❑Transportation Shipment
by Common Destination
Carrier
nDisinterment Date Cemetery Address
l l Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
Address
82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
Address
nice
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Sf q b Registrar of Vital Statistics J'�,JUL,,�'� hy�...J4,r45-
(signature)
District Number S�Sc Place 0,,p, y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w• Date of Disposition 05/04/2016 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
0)
(section) (lot number) (grave number)
Name of Sexton or Person in Char a of Premises St+�'44
(please print)
a' Signature /1� YC
9 (.�- Title
(over)
DOH-1555 (02/2004)