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Crozier, Brandon Joseph
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Brandon Joseph Crozier Male Date of Death Age If Veteran of U.S.Armed Forces, 09/10/2021 19 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 12 Dogwood Drive,Moreau Town,New York 12803 w Manner of Death � 0 Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined ©Pending W U Circumstances Investigation W Medical Certifier Name Title 0 David DeCelle Coroner Address 40 McMaster Street,Ballston Spa, New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 43 Burial Date Cemetery,Crematory or Facility Name 09/20/2021 Pine View Crenlbtory Entombment Address EiCremation Queensbury Town,New York Donation ZI=1Removal Date Place Removed and/or and/or Held ; ~ Hold Address N 0 O. Date Point of V) Li Transportation Shipment Q by Common - — Carrier Destination 0 Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 1— Remains are Shipped,If Other than Above Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/13/2021 Registrar of Vital Statistics Leeann Mc cube(ECectronicalrySigned) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IN Z Date of Disposition 61 IZl f Zq Place of Disposition en Lt.L ►✓`t-0---, al (address) W CC (section) n jlot number) �} (grave number) • Name of Sexton or Person in Charge of Premises ``i L MAAi O (pld3se print) �,��/ z d M�vr� • Signature Title DOH-1555(07/18)pi of 2 r 1. 5 162 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of - delivered on , 20 ' +r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#