Strunk, Christopher E e„.,, -tt -39,
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records 4 Burial - Transit Permi
Name First Middle Last Sex
Christopher E Strunk Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/03/2022 75 Years War or Dates 1966-1970
H Place of Death Hospital,Institution or
WCity,Town or Village Lake Luzerne Town Street Address 141 Harris Avenue, Lake Luzerne Town, New York 12846
p Manner of Death El Natural Cause Accident ElHomicide ESuicide ElUndetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI Lynn Keil PA
Address
1340 State Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Lake Luzerne District Number Register Number
City,Town or Village 5656 9
Burial Date Cemetery,Crematory or Facility Name
05/09/2022 Pine View Crematory
Entombment Address
Cremation Lake Luzerne Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
(/)ETransportation
p by Common Shipment
Carrier Destination
nDisinterment
Date Cemetery Address
III
Reinterment
Date Cemetery Address
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
E— Remains are Shipped,If Other than Above
Address
CC
LL)
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/09/2022 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed)
(signature)
District Number 5656 Place Town Of Lake Luzerne
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 51fP4 ZZ ..Place of Disposition '.)t I/_ , v_—
2 (address)
W
CCCC (section) /� (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises r.9 1�t
Z g
/T ease print)
W Signature Title ali01�1
6
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt -
Human remains of delivered on , 20
'Me View Cemetery Representing the funeral home named on burial permit
.cial Funeral Directors Reg. or License#