Brunelle, Kyle Matthew ift
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kyle Matthew Brunelle Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/13/2022 33 Years War or Dates
F- Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 52 Harrison Avenue, Kingsbury Town,New York 12839
WManner of Death Undetermined Pendin
Natural Cause Accident Homicide Suicide g
V Circumstances Investigation
WI Medical Certifier Name Title
0 Wesley Perry Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 23
Burial Date Cemetery,Crematory or Facility Name
11/21/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/17/2022 Registrar of Vital Statistics Cynthia ABardin('ECectronicaCCySigned)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition it 12Z i ii Place of Disposition
2 (address)
W
N CC (section) (lot number) (grave number)
Name of Sexton or Person in Char Premises •
(please print)
w (KIIIHTW
Signature Title
DOH-1555(07/18)p 1 of 2
^1 �°i
C. 1.64 2
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# '