Brandt, Mary Elizabeth 41 yo
LE
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Elizabeth Brandt Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/19/2022 85 Years War or Dates
F-. Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause Accident ❑Homicide ESuicide FlUndetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 218
Burial Date Cemetery,Crematory or Facility Name
® 04/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,Warren,New York
Donation
z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
CA Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
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
(— Remains are Shipped,If Other than Above
2 Address
C
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/20/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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: `
I— �-__`'
Z Date of Disposition H f III ZZ Place of Disposition i '"�"- r`--__
W (address)
W
U) (section) 4 (Got number) (grave number)
tE
0 Name of Sexton or Person in Charge of Premises1-- t114{�
Q a (p!e a print)
z a''�M14( <
W Signature Title
DOH-1555(07/18)p 1 of 2
.r dq 9
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#