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Russell, Bradford Lewis F) 11 NEW YORKSTATE DEPARTMENT OF HEALTH • Bureau of Vital.Records Burial - Transit Permit Name First Middle Last Sex Bradford Lewis Russell Male Date of Death Age If Veteran of U.S.Armed Forces, 11/03/2023 63 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation G Medical Certifier Name Title Kelly Maley PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 521 Burial Date Cemetery,Crematory or Facility Name 11/09/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held f- Hold Address N 0 d Date Point of (I)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to I Registration Number Name of Funeral Home Maynard D Baker Funeral Home 1 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above 2 Address CC W Cl. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/09/2023 Registrar of Vital Statistics Megan Wain(ECectronicallySigned) (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: I— W Date of Disposition If 113 313 Place of Disposition ?.16,E0,F�,,3 Cfc',F'M�ulaD-)rh 2 (address) W CC N (section) fflu__ (lot number) (grave number) SName of Sexton or Person in Charge ises f l' L . 1-G„n t Z (p1 se print) W Signature Title ( /41el TO DOH-1555(07/18)p 1 of 2 ,+ a i '; 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#