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Brown, Thomas Harry BY NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas Harry Brown Male Date of Death Age If Veteran of U.S.Armed Forces, 07/22/2021 79 Years War or Dates F. Place of Death Hospital,Institution or W City,Town or Village Albany Street Address St Peters Hospital p Manner of Death ©Natural Cause ❑Accident ❑Homicide Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title O Helen Cha MD Address 315 S Manning Blvd,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1837 EllBurial Date Cemetery,Crematory or Facility Name 07/23/2021 Pine View Crematorium Entombment Address ECremation Queensbury Town,New York Donation ZO Removal and/or Date Place Removed and/or Held H Hold Address 0 d Date Point of Cl) ❑Transportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom I_ Remains are Shipped,If Other than Above Address CC W • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/23/2021 Registrar of Vital Statistics Danielle S Gi[(espie(E(ectronicalTy 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: �,� � WDate of Disposition 7 2 44// Place of Disposition U . [ /je t;(,,�) 41 Ni 2 (address) W CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises K/�y��14'/4 L. / aca (please print) W Signature lf sl/ Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014972 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#