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Bryan Jr., John Buckley n 3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Buckley Bryan Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/16/2023 86 Years War or Dates 1957-1963 Place of Death Hospital,Instltotion or Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc 'p Manner of Death Natural Cause Accident Li Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title C3 Rick Teetz MD Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 227 Burial Date Cemetery,Crematory or Facility Name 04/18/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0Z❑Removal Date Place Removed and/or and/or Held H Hold Address 0 CL Date Point of N Transportation Shipment p by Common Carrier Destination O 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 F- Remains are Shipped,If Other than Above g Address CC LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/18/2023 Registrar of Vital Statistics (UilTon Moran(Electronically Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: (� "" — W Date of Disposition y l`t /3 Place of Disposition i address/ W CC (section) (lot number) (grave number) S Name of Sexton or Person in Charge remises t_ ft (pl se print) W Signature Title ('l76%- '� DOH-1555(07/18)p 1 of 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#