Satterlee, Brian L r �1`.^ . . 1
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brian L.Satterlee Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2022 55 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 43 Boulevard Apt. 1,Queensbury Town, New York 12804
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
Medical Certifier Name Title
O Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 166
Burial Date Cemetery,Crematory or Facility Name
11/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
�- Hold Address
0
O. Date Point of
U) Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
S Address
I
LL)
CI. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/07/2022 Registrar of Vital Statistics Caro(ine7fi&(egardl Barber(E(ectronicaltySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
▪ Date of Disposition 11 ig Ii L Place of Disposition '<not
2 (address
W
(section) 4,, (lotnumber)svvs., (grave number)
SName of Sexton or Person in Charge of Premises
%�� lease print) �,�
W Signature ���� Title � 'miUM.
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt J
Human remains of delivered on , 20 '
Pine View Cemetery Representing the funeral home named on burial/permit
Official Funeral Directors Reg.or License# "'