Brennan, David Patrick .. - /
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
David Patrick Brennan Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/05/2021 69 Years War or Dates 1969-1972
�.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 40 Sunnyside North,Queensbury Town,New York 12804
`p Manner of Death ❑X Natural Cause ID Accident ❑ Homicide ❑Suicide 0 Undetermined ❑Pending
U Circumstances Investigation
LU Medical Certifier Name Title
0 Gerard Abess MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 39
ElBurial Date Cemetery,Crematory or Facility Name
02/06/2021 Pine View Crematory
El Entombment Address
X❑Cremation Queensbury Town,New York
0 Donation
0 Removal Date Place Removed
and/or and/or Held
~ Hold Address
0
a. Date Point of
co ❑Transportation
CI by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
a Address
CC
Ill
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/05/2021 Registrar of Vital Statistics Carolnexkfegarie Bar&er(Ekctranicali'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:
W Date of Disposition j1 Place of Disposition
2 address)
W
U)
(section) (lot number) (grave number)
• Name of Sexton or Person in C r e of Premis �nc
Z (ple se print
W Signature Title oloittrUvi
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01.4 51. 1_
Receipt 1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#