Loading...
Pries, Richard W r(^_ NEW YORK STATE DEPARTMENT OF HEALTH ILF . Bureau of Vital Records Burial - Transit Permit Name First Middle Richard W.Pries Last Sex Date of Death Male 8/27/22Age If Veteran of U.S.Armed Forces, 79 War or Dates 1962-1968 f.. Place of Death Hospital,Institution or • Z City,Town or Village Hadley Street Address 22 Riverview Dr. Q Manner of Death Natural Cause U X Accident Homicide Suicide Undetermined ❑Pending WC1 Medical Certifier Circumstances Investigation Name Title Patricia A. Ford MD Address 179 Lawrence St.,Saratoga Springs, NY 12866 Death Certificate Filed Hadley District N Ller City,Town or Village Q Register-e Number Burial Date Cemetery,Crematory or Facility Name f 8/30/22 Pine View Crematory Entombment Address ©Cremation Queensbury, NY 12804 Donation OZ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of U)❑Transportation t7 by Common Shipment Carrier Destination Disinterment Date Cemetery Address ■ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home, Inc. 00211 Address 244 Church St., Lake Luzerne, NY 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address LC W a Permission is hereby granted to dispose of the human remains descri above as indicated. Date Issued 8/30/22 Registrar of Vital Statistics / ✓�/�2�,aA (signature/ District Number 4 5% Place Town of Hadley I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition g()0(•jZ Place of Disposition „M g (ad ress/ W N (section) (lot number) (grave number) Q GName of Sexton or Person in Charge of`'/11 ises AL, Li (pleasf print/ Signature Title ` ��( DOH-1555(0748)p 1 of 2 /'. �� Fly "V, n'. P... ,y.. Public Health Law Sec. 4145(2b) 1 Receipt 1 1 Human remains of delivered on , 20 1 1 IPine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ; -