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Edwards, Brent William . . ft7s / NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Brent William Edwards Male Date of Death Age If Veteran of U.S.Armed Forces, 09/16/2023 56 Years War or Dates 1986-1994 H Place of Death Hospital,Institution or Z City,Town or Village Hebron Town Street Address 20 Clark Way,Hebron Town,New York 12865 pManner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Hebron District Number Register Number City,Town or Village 5760 11 Burial Date Cemetery,Crematory or Facility Name 09/19/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York ▪Donation ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 n. Date Point of Cl) Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/18/2023 Registrar of Vital Statistics Dorothy Worthington(ECectronically Signed) (signature) District Number 5760 Place Town Of Hebron I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 1 1 �jj Place of Disposition 7L 4 W (address) W Cl) (section) ot number) (grave number) CC ,4„ "_ I1 O Name of Sexton or Person in Charge of Premises Z (plea print/ y� r W Signature Title "I ........ ‘ DOH-1555(07/18)p 1 of 2 1 1 , '.j l Public Health Law Sec. 4145(2b) Receipt 1 Human remains of , k delivered on , 20 _ ..._ f Pine View Cemetery Representing the funeral home name4 on burial permit Official Funeral Directors Reg.or License# %-K. '--