Hall, Brad itlig
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle . Last Sex
Brad L. Hall Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 10,2018 33 War or Dates
Place of Death Hospital, Institution or
Z° City, Town or Village Minerva Street Address State Rt. 28N
a Manner of Death I I Natural Cause X Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Francis W.Whitelaw
Address
60 Maple Lane,Bloomingdale,NY 12913
Death Certificate Filed District Number Register Number
City, Town or Village Minerva 1557
❑Burial Date Cemetery or Crematory
Entombment June 13,2018 Pine View Crematory
Address
M Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z
Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
coTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
l-• Remains are Shipped, If Other than Above
2 Address
Permission is hereby granted to dispose of the human emains described above as indicated.
Date Issued 1 1 Z ''Zv 1 S Registrar of Vital Statistics Q
(signature)
District Number 1557 Place Minerva
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition (,11311g Place of Disposition
W (address)
N
(section) if (lot num r) (grave number)
p Name of Sexton or Person in Charge of Premises ,,, s..M'Ifi
z (please print)
W Signature Title Mi
(over)
DOH-1555 (02/2004)