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Grant, Joshua R it 5-10 • s NEW YORK STATE DEPARTMENT OF HEALTH Burial •- Transit •Permit Bureau of Vital Records Name First Middle Last Sex Joshua R.Grant Male Date of Death Age If Veteran of U.S.Armed Fo 07/16/2023 33 Years War or Dates Place of Death Hospital, ion or Z City,Town or Village South Glens Falls Village Street Address 48 Harrison, South Glens Falls Village, New York 12803 p Manner of Death 0 Natural Cause Accident El Homicide Suicide Undetermined []Pending W Circumstances II I'Investigation W Medical Certifier Name d' Title CI David DeCelle oroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed Village Of South Glens I District Num Register Number City,Town or Village 71.f 4524 15 Burial Date Cemetery,Crematory or Facility Na 07/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held h- Hold Address N 0 C. Date Point of U)❑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 l` Remains are Shipped,If Other than Above 2 Address CC LLJ a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/20/2023 Registrar of Vital Statistics Samantha Berg(Electronically Signed) (signature) District Number 4524 Place Village Of South Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /� I-- / ,/ Z Date of Disposition ?I Z3 Place of Disposition (` "���� ���'""`ttt���--___ W N (section) (lot number) (grave number) CC 0Name of Sexton or Person in Charge of Pre A rt ii..._ ae riot/ f4 P W Title i� lk Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) , .r f Receipt • IHuman remains of _ derWred on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#