Hutt, Brian NEW YORK STATE DEPARTMENT OF HEALTH JIf It
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Brian J. Hutt Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/11/2018 57 War or Dates no
Place of Death Hospital, Instituti'
City, Town or Village Hadley Street Address
668 N. Shore Rd.
Manner of Death®Natural Cause El Accident 0 Homicide El Suicide El Undetermined El Pending '
Circumstances Investigation
Medical Certifier Name ( Title
Marc it ajctS . p
Address
Corinth, NY
Death Certificate Filed District Nu4 Register Number
City, Town or Village Hadley 1-)S—s ' /1
❑Burial Date Cemetery or Crviatory
11/13/2018 Pine View Cremal
❑Entombment Address
®Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
n Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
unDate Cemetery Address
Reinterment
s Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
Address
24 Church St., Lake Luzerne, NY 12846
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human re 'ns described above as indicate
Date Issued 11/13/2018 Registrar of Vital Statistics j� = c "
(signature)
District Number .y55' Place Town of Hadley
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ION ligg Place of Disposition .�+ 4...,-4drtf.-
(address)
(section) (lob numb ) (grave number)
Name of Sexton or Person in Charge of Premi es �<<*, pnntl
9 (pie i a pnnt)
Signature Title AffIRTit
(over)
DOH-1555 (02/2004)