Bremman, Willaim Patrick . P-)ILf
NEWYORKSTATEDEPARTMENTOFHEALTH t
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
William Patrick Brennan Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/11/2021 90 Years War or Dates 1949-1953
l.. Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 71 Longview Drive 283,Queensbury Town,New York 12804
p• Manner of Death El Natural Cause 0 Accident 0 Homicide ❑Suicide 0 Undetermined El Pending
V Circumstances Investigation
WIMedical Certifier Name Title
Paul Filion MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 11
❑Burial Date Cemetery,Crematory or Facility Name
01/13/2021 Pine View Crematory
Ei Entombment Address
iCremation Queensbury Town,New York
ElDonation
0 0 Removal Date Place Removed
and/or and/or Held
H N Hold Address
0
n- Date Point of
(/) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
Address
1E
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/13/2021 Registrar of Vital Statistics Carolnexkkgard Barb-ergkctronica/T Signed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
W Date of Disposition I/13)Z I Place of Disposition n-.Vh. „JCL„_
2 (address)
W
N
re (section) 4iot number/ (grave number)
O Name of Sexton or Person in Char of Premises t �.. V Will
Z (ptea print)
W /..Signature Title ��'N^'" Nr'�
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014 410
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#