Branion, Michael L LF -Pt ill
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael L.Branion Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/11/2023 58 Years War or Dates
1_ Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 698 Coach Road,Argyle Town,New York 12809
WManner of Death ri Natural Cause []Accident ❑Homicide []Suicide []Undetermined Pending
V ` 'Circumstances Investigation
GMedical Certifier Name Title
Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 28
Burial Date Cemetery,Crematory or Facility Name
05/15/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
Date Point of
N[]Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Ei Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/15/2023 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 5-11S 17.3 Place of Disposition
2 (address)
W
N CC (section) 7 (lot number) (grave number)
gName of Sexton or Person in Charge of Pr ises Ar
Z /p ase print)
W Signature Title ��tiMHt?�C
DOH-1555(07/18)p 1 of 2
1
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#