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Brownell, Warren L
1 (LF) 4104> NEW YORK STATE DEPARTMENT OF HEALTH `- `Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Warren L Brownell Male Date of Death Age If Veteran of US.Armed Forces, 12/24/2023 75 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Saratoga Springs Street Address Saratoga Hospital 0 Manner of Death El Natural Cause Accident1:1 Homicide nSuicide riUndetermined ri Pending W Circumstances Investigation W Medical Certifier Name Title O Jason Bemad MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 726 Burial Date Cemetery,Crematory or Facility Name • 12/27/2023 Pineview Crematory Entombment _ Address ©Cremation Oueensbury Town,New York Donation 6 EI Removal Date Place Removed - and/or and/or Held F- Hold Address CD O Date Point of N❑Transportation Shipment Q by Common Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above S Address Q W U. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/26/2023 Registrar of Vital Statistics Dillon Moran(Electronically Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- W Date of Disposition /j-Z- Z-2, ,Place of Disposition P. .J e V;&) e�^Cyr/a./ri 2 (address) W N CCf(section) /lotn mber, (grave number) SName of Sexton or Person in Charge remis KMa>pit,,�� L✓k z — l_/please print/ W Signature - f/-' Title "b DOH-1555(07/18)p t of 2 "`d ._ . 0 1.7794 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#