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Braidwood, John Alexander , 4... * i g ti NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Alexander Braidwood Male Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2022 77 Years War or Dates E Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital ,p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined 0 Pending V Circumstances Investigation WD Medical Certifier Name Title Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 130 ElBurial Date Cemetery,Crematory or Facility Name 03/01/2022 Pine View Crematory ❑Entombment Address IDCremation Queensbury,New York • El Donation f❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 N ❑Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/28/2022 Registrar of Vital Statistics .Megan Not-in(Electronically Signed) (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: W Date of Disposition 3/l I 77_ Place of Disposition 47 y ddress) W CD CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge f remises41 �Gvnll 11 Z (pl se print) , W I0 Signature Title i0eL DOH-1555(07/18)p i 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#