Braband, Frederick E ELI° F # 3 13
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frederick E Braband Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/08/2022 72 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Edinburg Town Street Address 32 Partridge Road,Edinburg Town,New York 12134
W Mannerof Death
0 {]Natural Cause IllAccident El Homicide Duicide Undetermined {]Pending
C.) Circumstances 'Investigation
LU Medical Certifier Name Title
0 David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed Town Of Edinburg District Number Register Number
City,Town or Village 4555 2
Burial Date Cemetery,Crematory or Facility Name
® 05/11/2022 Pineview Crematory
Entombment Address
{]Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
p: Hold Address
0
d. Date Point of
(I){]Transportation
p by Common Shipment
Carrier Destination
{]Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
-. Remains are Shipped,If Other than Above
Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/10/2022 Registrar of Vital Statistics Denise Ferguson(Electronically Signed)
(signature/
District Number 4555 Place Town Of Edinburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition S'Ill lZ Place of Disposition _- (A,t,(L
2 (address)
W
CC N
(section) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises �(61 ^^^
Z (prse pnnt)
W Signature L✓ .C� Title Ir' r' ��
DOH-1555(07/18)p 1 of 2
15S
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#