Zilm, Frederick A NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frederick A.Zilm Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/21/2022 80 Years War or Dates 1961-1965
Place of Death Hospital,Institution or
City,Town or Village Lake Luzerne Town Street Address 51 Boat Launch Drive, Lake Luzerne Town,New York 12846
ILI
WManner of Death ❑X Natural Cause Accident ❑Homicide Suicide FlUndetermined ❑Pending
I—ICircumstances Investigation
uW Medical Certifier Name Title
John Pezzulo DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Lake Luzerne District Number Register Number
City,Town or Village 5656 10
Burial Date Cemetery,Crematory or Facility Name
05/23/2022 Pine View Crematory
Entombment Address
MCremation Queensbury Town,New York
Donation
ozRemoval Date Place Removed
and/or and/or Held
pHold Address
0
0. Date Point of
(AATransportation
Ci by Common Shipment
Carrier Destination
11
Date Cemetery Address
Disinterment
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
Remains are Shipped,If Other than Above
', Address
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/23/2022 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:
Z Date of Disposition ,S1241 I ZZ Place of Disposition 171t 1L._ 4111r....�
(address)
CC
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises A t^ AA IT
Tit
(pld se print/
Signature G—./' � Title tier/Mil Tag—
DOH-1555(07/18)p 1 of 2
I :; r;
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#