Bigelow Jr., Brian Robert .__ .. . 4 $61)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brian Robert Bigelow Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/22/2021 37 Years War or Dates
1-• Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death g Natural Cause El Accident El Homicide El Suicide Undetermined 0 Pending
W Circumstances Investigation
V alMedical Certifier Name Title
C/ Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 413
0 Burial Date Cemetery,Crematory or Facility Name
09/23/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
0 Donation
Z 0 Date Place Removed
Removal and/or Held
— and/or
N
- Hold Address
0
Date Point of
N Li Transportation Shipment
p by Common
Carrier Destination
Ei Disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
" Address
It
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2021 Registrar of Vital Statistics RoaetJndsetu Curtis(ETectronica/lySwned9
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F /
WINDate of Disposition q� 1'I+ Place of Disposition 471�Ur d . Or�-
(address)
(section) (lot number) (grave number)
IE G Name of Sexton or Person in Charge of Pre .ses f%p/ e print) / .it4
W Signature �/ Title (a`' if
g �'
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral•home.named on burial permit
Official Funeral Directors Reg.or License#