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Bourdeau, Willard R (\1f ) �'942? NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Willard R Bourdeau Male Date of Death Age If Veteran of U.S.Armed Forces, 11/17/2023 84 Years War or Dates 1963-1969 Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death �Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation CI 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 535 Burial Date Cemetery,Crematory or Facility Name 11/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held - Hold Address 0 a Date Point of (I)EITransportation CI Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 F Remains are Shipped,If Other than Above 2 Address CC LU C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/20/2023 Registrar of Vital Statistics Megan Nolin(Electronically 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: IH W Date of Disposition ,1,ZZ-zoj3 Place of Disposition 'JJ P i/, e,�) 2 (address) W N (section) (1 t number) (grave number) GName of Sexton or Person in Charge of Premises �i/yer..✓D ,�C� Z / 11 (please print) W Signature Title ortord.Tor DOH-1555(07/18)p 1 of 2 1 0Public Health Law Sec. 4145(2b) ;. f Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#