Griesmer, Edward Kenneth 33 .
NEW YORK STATE DEPARTMENT OF HEALTH _ it'
Burial - Transit Perm
Bureau of Vital Records
Name First Middle Last Sex
Edward Kenneth Griesmer Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/11/2023 83 Years War or Dates
H Place of Death Hospital,Institution or
Z City,T own or Village Queensbury Town Street Address 39 Longview Drive 129,Queensbury Town,New York 12804
pManner of Death Il Natural Cause Accident n Homicide Suicide Undetermined Pending
0 Circumstances Investigation
W Medical Certifier Name Title
CI Michael Miles MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury ' District Number Register Number
City,Town or Village 5657 55
7Burial Date Cemetery,Crematory or Facility Name
04/12/2023 Pine View Crematorium
ntntombment Address
X Cremation Queensbury Town,New York
nDonation
Date Place Removed
(n oval and/or Held
F and/or
U3
Hold Address
0
Date Point of
t/)I Transportation Shipment
p by Common —,
Carrier Destination
Date Cemetery Address
uDisinterment
r-Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
i-- Remains are Shipped,If Other than Above
g Address
CC
W
11' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/11/2023 Registrar of Vital Statistics Caroline.-lifeegarde Barber(Electronically Signed)
(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:
I-
W Date of Disposition ilk!l3 Place of Disposition �',l(ddress)
W
COCC (section) (lot number) ( (grave number)
gn Name of Sexton or Person in Charge of Premises 1� vwt I�
Z (Tease print)
W Signature Title AZ
DOH-1555(07/18)p 1 of 2
w..,.
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#