Bradway, Walter A # 2 zi.
t_
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
4'
Name First Middle Last Sex
Walter A.Bradway
Male
- Date of Death Age If Veteran of U.S.Armed Forces,
03/06/2022 60 Years War or Dates
Place of Death Hospital,Institution or
ill City,Town or Village Johnsburg Town Street Address 80 Main Street,Johnsburg Town,New York 12853
W Manner of Death El Natural Cause Accident El HomicideSuicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
O Kate Sauer-Jones PA
Address
rz 112 Ski Bowl Rd,Johnsburg Town,New York 12853
,-,k Death Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 5
-- Date Cemetery,Crematoryor FacilityName
Burial rY�
Z' 03/12/2022 Pine View Crematory
Entombment Address
▪MCremation Queensbury Town,New York
Donation
i
ElRemoval Date Place Removed
• and/or and/or Held
0Hold Address
0
4 Date Point of
Cl)OTransportation
Q by Common Shipment
Carrier Destination
IX
• ❑Disinterment
Date Cemetery Address
E
IIDate Cemetery Address
• I__I Reinterment
fir;, Permit Issued to Registration Number
f, Name of Funeral Home Alexander Baker Funeral Home 00037
Address
F 3809 Main St,Warrensburg,New York 12885
17„ Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped,If Other than Above
g Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued 03/11/2022 Registrar of Vital Statistics Jean M Comstock(ElectronicalySigned)
(signature)
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H'
WDate of Disposition .-//-2OZZ. Place of Disposition }�,'4e t.J'Gu) et-- m ,rci
2, (address)
w
CC (section) ,/ (lot number) (grave number)
dName of Sexton or Person in Charge of Premis ��i mo^��
Z print)
zCLI
Signature (please.-------,-„
0/9 Title 0re.rl./D{
DOH-1555(o7/18)p 1 of 2
1, ,c> / f
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#