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Fausner, John T . (0NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John T. Fausner Male Date of Death Age If Veteran of U.S.Armed Forces, 12/16/2023 91 Years War or Dates 1953-1955 F., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital w Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide V Circumstances Investigation W Medical Certifier Name Title C3 Julia Bottoni MD 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 594 Burial Date Cemetery,Crematory or Facility Name 12/19/2023 Pine View Crematory Entombment Address ,©Cremation Queensbury Town,New York Donation 60 Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of (/)OTransportation p by Common Shipment Carrier Destination III Disinterment Date Cemetery Address El 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 H Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/19/2023 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: l- Z Date of Disposition iz In 113 Place of Disposition s sJ CL) (pi 71,0TA/.` IJJ 2 (address) W O (section) (lot number) ii (grave number) 0 Name of Sexton or Person in Charge of Premises %for Z .::.. (pi se print) W Signature Title ��� rt( DOH-1555(07/18)p 1 of 2 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#