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Kruger Jr., Paul Oh- • �, tie) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul Kruger Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 07/26/2021 93 Years War or Dates 1945-1948 Place of Death Hospital,Institution or Z City,Town or Village Hadley Town Street Address 6269 State Route 9N,Hadley Town,New York 12835 ILI `p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation WMedical Certifier Name Title CI Amy Johnson PA Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 15 ❑Burial Date Cemetery,Crematory or Facility Name 07/28/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of (J) ❑Transportation ES Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 F— Remains are Shipped,If Other than Above 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/27/2021 Registrar of Vital Statistics Pauline G Smead(Electronically Signed) (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition 7—},9—1,1 Place of Disposition Pjhc. l�iGl✓ Gr�rnclorY W (address) W LE N (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises JCtt'i Y S !bfc.S Z (please print) W Signature / vli+ Title C,re, LQb r TTT��� DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) "* ' ;`` _ � Receipt Human remains of ' delivered on , 20 I ) ine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#