Wester, Douglas L Sr. LOF it goy
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Douglas L.Wester Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2022 79 Years War or Dates
ZPlace of Death Hospital,Institution or
W City,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death IINaturalCause Accident Ei Homicide ESuicide Undetermined Pending
LUI
0 Circumstances Investigation
WW Medical Certifier Name Title
CI Hung Nguyen MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 306
Burial Date Cemetery,Crematory or Facility Name
e 05/16/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
O. Date Point of
Cl)nTransportation
p by Common Shipment
Carrier Destination
oDisinterment Date Cemetery Address
❑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
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/16/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W _. ,1
Z Date of Disposition Sl 11 i Z Z Place of Disposition
2 (address)
W
N
CC (section) (lot number) 5,11 (grave number)
aName of Sexton or Person in Charge of Premises t►1 _ tit
Z lease print/
W Signature /'// c . Title (WItfOti
DOH-1555(07/18)p 1 of 2
T) 171 1
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#