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Bradley, Patrick William
41- qto NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patrick William Bradley Male Date of Death Age If Veteran of U.S.Armed Forces, 05/31/2021 68 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village South Glens Falls Village Street Address 25 William Drive,South Glens Falls Village,New York 12803 • Manner of Death © Natural Cause ❑Accident El Homicide 0 Suicide 1:1Undetermined ❑Pending W Circumstances Investigation LU• MediE t Certifier Name Title CI Thomas Coppens MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 13 Burial Date Cemetery,Crematory or Facility Name 06/03/2021 Pine View Crematory ElEntombment Address X❑Cremation QueensFyn,New York ▪Donation ��! 6 El Removal Date Place Removed and/or and/or Held H Hold Address rn 0 Date Point of N Transportation Shipment by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment 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 H Remains are Shipped,If Other than Above g Address fr W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/03/2021 Registrar of Vital Statistics Shannon Kelleher(Electronically Signed) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition f�P( lu IT( Place of Disposition address/ 0 W CC N (section/ tot number) (grave number) O Name of Sexton or Person in Charge of Premises vt A�Y (please int/ Z l'� `D e ttret W Signature Title DOH-1555(07/18)p 1 of 2 14827�Public Health Law Sec. 4145(2b) �- Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on bu ' .1 permit Official Funeral Directors Reg.or License#