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Brown, John Joseph 331f NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Joseph Brown Male Date of Death Age If Veteran of U.S.Armed Forces, 02/06/2021 88 Years War or Dates Korea Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 44 Willowbrook 301,Queensbury Town,New York 12804 `p Manner of Death ©Natural Cause ElAccident ElHomicide ❑Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Ellen Deprey PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 40 Burial Date Cemetery,Crematory or Facility Name 04/08/2021 Pine View Crematory Entombment Address IDCremation Queensbury Town,New York ❑Donation ZO Removal Date Place Removed and/or and/or Held N Hold Address O d Date Point of Cl) 1-1 Transportation p by Common Shipment Carrier Destination 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 St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above 2 Address CC W n Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2021 Registrar of Vital Statistics Caroline 7fi&legarieBarber(ECectronica1tySigned) (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: ZDate of Disposition 1-1 Place of Disposition -RA11,,, 2 (address) CC CC (section) (0 number) (grave number) 0 Name of Sexton or Person in Charge of Prem. s "e') 3;""'^r Z (please pit) W Signature Title (;c DOH-1555(07/18)p 1 of 2 14 Public Health Law Sec. 4145(2b) 014 7 n 2- Receipt Human remains of delivered on , 20 ' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#