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Mulson, Thomas P f1sI NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas P.Mulson Male Date of Death Age If Veteran of U.S.Armed Forces, 02/13/2022 60 Years War or Dates f.. Place of Death Hospital,Institution or WCity,Town or Village Lake George Town Street Address Prospect Mountain Highway,Lake George Town,New York 12845 p Manner of Death L jr-1 Natural Cause ©Accident 0 Homicide 0 Suicide 0 Undetermined Pending WEj V Circumstances Investigation 0 Medical Certifier Name Title Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Lake George 5651 4 Burial Date Cemetery,Crematory or Facility Name 02/15/2022 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York 0 Donation ZRemoval Date Place Removed H and/or and/or Held N Hold Address 0 a Date Point of co Li 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 Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/15/2022 Registrar of Vital Statistics Patricia R McKinney-Schuster(Electronically Signed) (signature) District Number 5651 Place Lake George, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition 2/I I�7 Place of Disposition PirtlU� f to � 2 (address) 6 W U) CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of P miles �� �fM�l�t Z (lease print/ W Signature Title (t t ive DOH-1555(07/18)p 1 of 2 15651 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#