Brayton, Anthony # 7
NEW YORK STATE DEPARTMENT OF HEALTH J
Vital Records Section Burial - Transit Per
mit
s
Name First addle Last Sex
Anthony Wilson Brayton Male
Date of Death Age If Veteran of U.S.Armed Forces,
September 3, 2013 48 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Street Address 7 Third Street
, . Manner of Death 0 Undetermined 0 Pending
r X Natural Cause Accident Homicide Suicide Circumstances Investigation
,v: Medical Certifier Name Title
Dr Robert Sponzo,MD
Address
II''r Glens Falls,NY
Death Certificate Filed District Number Register N tuber
City, Town or Village V1r)�-AN )1� l\ _ � (03 j
0 Burial Date Cemetery or Crematory
Entombment September 5,2013 Pine View Crematorium
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
0 Removal and/or Held
and/or Address
a. Hold
Date Point of
cn Li Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
`'r` Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01444
Address
194 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 hereby ranted to dispose of the human ains describeve as indicated.
Date Issued Registrar of Vital Statistics
(signature
District Number c)i Place O A) 0\.1 \VOA-l�I'll-6xr\ �,
4 y
I certify that the remains of the decedent identified above Were disposed of in accordance with this permit on:
Z
W Date of Disposition 1lbl(3 Place of Disposition �['H,V,a,J Cren4for,.r'
2 (address)
tn
(section) A (lot numbers (grave number)
QName of Sexton or Person in Charge of Premises t: to
Z / ( ease print)
141
Signature I -4- Title Cariblii.00
(over)
DOH-1555(02/2004)