Brennan, Joseph Robert It 221
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joseph Robert Brennan Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/08/2022 79 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
C Manner of Death
Natural Cause Accident Homicide Suicide Undetermined riPending
VCircumstances Investigation
flMedical Certifier Name Title
David Cunningham MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 151
Burial Date Cemetery,Crematory or Facility Name
03/10/2022 Pine View Crematory
Entombment Address
OCremation Queensbury,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
N Hold Address
Transportation Date Point of
D by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1. Remains are Shipped,If Other than Above
2 Address
MC
W
di
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/10/2022 Registrar of Vital Statistics !Megan Noltn(E(ectronicalrySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
11.1
v
Z Date of Disposition 3)19(22 Place of Disposition ,qt ` Zforl•• ••-
2 (address)
IW
N
Q (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of remises ('r 4[(lt
Z (plea
e print) �,R'
W Signature �,� Title MW�
DOH-1555(07/18)p i of 2
0 1 5870
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#