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Brooks, Harold James , . _., in(3._,ir-..\ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Harold James Brooks Male Date of Death Age If Veteran of U.S.Armed Forces, 08/01/2023 90 Years War or Dates Air Force • Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 222 South Street,Glens Falls,New York 12801 111 CI Manner of Death 0 Natural Cause Accident 0 Homicide 0Suicide FlUndetermined riPending W Circumstances Investigation W Medical Certifier Name Title CI Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 362 Burial Date Cemetery,Crematory or Facility Name 08/03/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York :Donation 6❑Removal Date Place Removed - and/or and/or Held H- Hold Address N O. Date Point of to Transportation Shipment `Q by Common Carrier Destination Disinterment Date Cemetery Address jEl Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F.., Remains are Shipped,If Other than Above '_. Address I Ui O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/03/2023 Registrar of Vital Statistics Megan Notin(E(ectronica1Ty 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: Date of Disposition ?t ZoZ-3 Place of Disposition p o 5 e ti:-e„J (f- -ra.t P1 ut (address, W CC (section) (y num r) (grave number) 8 Name of Sexton or Person in Cha of Pr m. e fq T i o.J WOO ci Z _ / ` (please print) W Signature f< G Ae Title V�P>�r +�r DOH-1555(07/18)p t of 2 4 T .: Public Health Law Sec. 4145(2b) * s. ‘ , ' �����) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#