Whipple, Brandon J 724)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brandon J Whipple Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/24/2021 25 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Corinth Town Street Address 123 Gabriel Road,Corinth Town,New York 12822
W Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
WMedical Certifier Name Title
0 Susan Hayes-Masa Coroner
Address
40 McMaster Street,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Corinth 4553 19
❑Burial Date Cemetery,Crematory or Facility Name
08/27/2021 Pineview Crematory
ElEntombment Address
0 Cremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
d Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
a Address
Q
W
13" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/27/2021 Registrar of Vital Statistics Brenda L Penis(Electronically Signed)
(signature)
District Number 4553 Place Corinth, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 9-2 .-Z.�Z/ Place of Disposition )T Y �7 1 J 4J Gr^ cl G�
(address)
W
(section) (lot number) (grave number)
Name of Sexton or Person in a of Premises j �"� �� a4-- G
(please print)
Signature Title C CP kfryC��'
DOH-1555(07/18)p 10
01 5086
Public Health Law Sec. 4145(2b)
1 Receipt
Human remains of delivered on , 20
y p g - .
fine View Cemeter • Rep resen f`i' the funeral home named on burial permit
Official Funeral Directors Reg.or License#