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Locke, Noah James 41 MD NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Noah James Locke Male Date of Death Age If Veteran of U.S.Armed Forces, 07/16/2021 2 Mos.6 Days War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital W Manner of Death Undetermined Pending W ❑Natural Cause ❑Accident ©Homicide Suicide ❑ Circumstances Investigation W Medical Certifier Name Title 0 Timothy Cavanaugh Coroner Address 112 State Street,Albany,New York 12207 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1797 Burial Date Cemetery,Crematory or Facility Name 07/19/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation ZO El Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of (/) Li Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/19/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF— Z Date of Disposition 11 iy IT( Place of Disposition ntV 2 (address) W Cl) (section) ` (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pr ises (/ K� '411 Z (pie se print) IL Signature Title 4 '"Nl�l� DOH-1555(o7/t8)p i of 2 #asuaon zo•2ag siopauu tenun3 PPM ;iuuad p unq uo pauiiu auuoq j Jaun3 alp Duuuasardag tiaiatuoD main aura l K 0Z ` uo pazaniiap Jo sureuzaJ ueuznH idtaaag (aZ)Sbit '00S Awl 111ivaH atignd