Brown, Aaron NEW YORK STATE DEPARTMENT OF HEALTH 4 L+ t
Burial - Transi Permit
Vital Records Section
Name Firs Middle Last Sex
aron Paul Brown Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/21/2012 43 years War or Dates 1987-93
.1 - e of Death Hospital, Institution or
i - - , " :ge Utica, NY Street Address Happy Journey Motel Utica, N Y
0 Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ®Pending
Uj Circumstances Investigation
W Medical Certifier Name Title
Stephen S.Wolanin Coroner
AdSIe s
u Nsew Hartford St. New York Mills, N Y 13417
Death Certificate Filed District Number Register Number
(City,)T Xr WWI City Of Utica 3202 568
❑Burial Date Cemetery or Crematory
09/25/2012 Pine View Cemetery
Mi.:['Entombment Address •
,Cremation Queensbury, N Y
Date Place Removed
Z Ei 1-1 Removal and/or Held
and/or Address
M= Hold
In
0 Date Point of
Cti
❑Transportation Shipment
0 by Common Destination
sii Carrier
ii ❑Disinterment Date Cemetery Address
i:i❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
11 Lafayette St. Queensbury, N Y 12804
qi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
1Z.
L
"i` Permission is hereby granted to dispose of the human remains described above as indic ted.
;; 09/24/2012 Date Issued Registrar of Vital Statistics _____4 �,��
(sgnat )
District Number 3202 Place City Of Utica
•• : I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
Ili Date of Disposition Place of Disposition
2 (address)
L
tia
r (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
2 (please print)
III
Signature Title
(over)
DOH-1555 (02/2004)
NEW YGNI•(STATE DEPARTMENT OF HEALTH f _ '� (Ili
Vital Recc-r+1s Section •
Burial - Transit Permit
MINIIIIIIMPOIMIN
NWT-_ Firs - Middlea-ul Last n 1 Sex dale
Dame,of Death Age If Veteran of U.S.Armed Forces.
(If)i:1/2012 43 years War or Dates 1987-03
r,..e et-Death Hospital, Institution or:.a! -erV4Nage Utica, NY Street Address HapwS,Jamey Motel Utica.N Y
nar of Death a Natural Cause 0 Accident Q Homicide Q Suicide Q Undetermined Pending
_ Circumstances Investigation,
w Me+1°c>J Certifier Name Title
Stephen S.Walanin • Coroner
A. ess
ai New Hartford St. New York Mills,N Y 13417
Death,_ertiticate Filed District Number Register Number
C Y; rljla( ( City Of Utica 3202 58$
" Cemetery or Crematory
Date
Btn ia; 0W2512012
Pine yew Cemetery
❑Entombment Address - -
21Ciernation Queensbury,N Y
Date • Place Removed
' •❑flqrnc'val and/or Held
-
�,. Emd)cr Address
Helc
Date Point of
❑Trar:sportation Shipment
. 5 t.y:;cmmon Destination
m Disinterment
Date Cemetery Address
1�1 _ Date 1 Cemetery Address - -
Ft��ir.t��rment
Permit Issued to • Registration Number
EtisLane of Funeral Home Maynard D. Baker Funeral Home • • 01130
Adcress
"I Lafayette St. aueensbury,N Y 12804
Name of Funeral Firm Making Disposition or to Whom •
. Renla),IS are Shipped, If Other than Above
Address •
x Perin€fi;fon is hereby granted to dispose of the human remains described above as indi tad.
ei Data Issued 00/24/2012 Registrar of Vital Statistics .s__�j ti--„
oig
District Number 3202 Place City Of Utica
. •71 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i Date of Disposition `1111.j IL Place of Disposition Ana O e1J Ch4tOr r
(address)
y:,
,'.� (secton) Or mbar) ( (grave number)
• 1) el" elf•
ram, Name of Sexton or Perso in Charge of remises ( �
,,,, Signatcra
L Title
---- (over)
•
DOH-15 35 (02/2004)