King, Brett NEW YORK STATE DEPARTMENT OF HEALTH - 11 q tr"
Vital Records Section BurialTransit Permit
Name First Middle Last Sex
Brett Michael King Male ,
Date of Death Age If Veteran of U.S. Armed Forces,
08/11/2013 2 months War or Dates No
#- Place of Death Hospital, Institution or
Z City, Town or Village City of Albany Street Address Albany Medical Center
IliManner of Death❑Natural Cause ❑Accident ®Homicide ❑Suicide ❑Undetermined ❑Pending
LLt Circumstances Investigation
tu Medical Certifier Name Title
0 Timothy Cavanaugh, Coroner
Address
112 State Street Albany, NY 12207
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 101 15 Li I
0 Burial Date Cemetery or Crematory
08/19/2013 Pine View Crematorium
['Entombment Address
®Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
Tr and/or Address
r: Hold
0 Date Point of
Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main Street Hudson Falls, NY 12339
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z Address
#L
` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued CO 13/lb i 3 Registrar of Vital Statistics �G,,,,�a,e, /1 . lc IA
(signature)
District Number ) o 1 Place C__; a f- b 0-n y l NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lEf Date of Disposition Q 424I3 Place of Disposition ,g
2 (address)
LU
>1
CC (section) (lot umber) (grave number)
Name of Sexton or Person i Charge of P mises t,i St""ei+
z `` (p ase print)
l Signature 1. Title 626.14/41-0Q—
(over)
DOH-1555 (02/2004)