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Clute, Raymond S
- LUF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Raymond S.Clute . —.. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/16/2023 64 Years War or Dates F, Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ID Natural Cause []Accident []Homicide 0Suicide FlUndetermined ❑Pending W C.) Circumstances Investigation W Medical Certifier Name Title 0 Scott Biased MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 197 EBurial Date Cemetery,Crematory or Facility Name 04/18/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held I Hold Address N 0 d Date Point of t/) Transportation Shipment Q by Common -- Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above g Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/17/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 W VI I— of Disposition `I I I Place of Disposition -F(t. lL t abdress) W U) (section) lot number) (grave number) O Name of Sexton or Person in Charge of Premi s �"�`)L—" "' Q (plbase print) // W Signature Title (e�MilLT2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 f . Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#