Loading...
Nelson, Bradley S. ILr.l..—F-0) 4789 NEW YORK STATE DEPARTMENT OF HEALTH r Burlal - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bradley S.Nelson Male Date of Death Age If Veteran of U.S.Armed Forces, 03/25/2023 47 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Bolton Town Street Address 4571 Lake Shore Drive 25,Bolton Town, New York 12814 p Manner of Death El Natural Cause Accident Homicide Suicide ❑Undetermined El Pending W V Circumstances Investigation QW Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Bolton District Number Register Number City,Town or Village 5650 4 Burial Date Cemetery,Crematory or Facility Name 03/28/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed H and/or and/or Held CO Hold Address 0 O. Date Point of t/) Transportation fa Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2023 Registrar of Vital Statistics Jodi Eetteys(Efectronicaffy Signed) (signature) District Number 5650 Place Town Of Bolton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 3)ZglZ3 Place of Disposition R..IL efo _ 2 (address) W Cl) CC (section) (lot number) (grave number) SName of Sexton or Person in Charge of Pre ' `'^ �— -41 Z /,T ease print) IU Signature ' Title 6i2 f DOH-1555(07/18)p 1 of 2 >, Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20.' . i /1 a fA ` Pine View Cemetery Representing die funeral home named on burial permit Official Funeral Directors Reg.or License#