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Russo, Ronald M NEW YORK STATE DEPARTMENT OF HEALTH -14 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ronald M.Russo Male Date of Death Age If Veteran of U.S.Armed Forces, 12/08/2021 78 Years War or Dates 1964-1970 Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital W 'p Manner of Death ©Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation MI Medical Certifier Name Title 0 Rodney Ying MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 720 ❑Burial Date Cemetery,Crematory or Facility Name 12/09/2021 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 EL Date Point of ❑Transportation p by 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 1— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/09/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition I"LlIOJZ) Place of Disposition itt)f.— AOt:,)e — W 2 (address) W N (section) (lot number) (grave number) r C �++` `S1 4 I el Name of Sexton or Person in Charge of Premi es � Z (lease print) W Signature . Title /01M�F�- DOH-1555(07/18)p 1 of 2 0 . 5 4 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#