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Collyer, Steven G LE ii c3-0 NEW YORK STATE DEPARTMENT OF HEALTH .......J Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Steven G.Collyer Male Date of Death Age If Veteran of U.S.Armed Forces, 06/27/2023 73 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare pManner of Death ❑ ❑ ❑ ❑ ❑Undetermined ❑Pending W Natural Cause Accident Homicide Suicide C..) Circumstances Investigation W Medical Certifier Name Title CI Deborah Norris NP Address 4573 State Route 40,Argyle Town, New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 35 Burial Date Cemetery,Crematory or Facility Name O6/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0Z❑Removal Date Place Removed and/or and/or Held I— Hold Address N 0 ... d. Date Point of U)❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address El 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 E.- Remains are Shipped,If Other than Above 2 Address Q ILL) O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/29/2023 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 11 Place of Disposition 4;"--- ILI 2 (address) W N CC (section) 4 (lot number (grave number) gName of Sexton or Person in Charge of Pr ' e" t Z 14ease print) � W Signature Title [t-6r11617ee DOH-1555(07/18)p 1 of 2 • -7 f 1 ,f 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#