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Hedger, Carl S OLF 4F0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carl S.Hedger Male Date of Death Age If Veteran of U.S.Armed Forces, 01/29/2024 86 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W p Manner of Death El Natural Cause Accident El Homicide Suicide Undetermined Pending Ill 0 Circumstances Investigation W Medical Certifier Name Title 0 Jeremy Di Bari MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 61 ElBurial Date Cemetery,Crematory or Facility Name 02/05/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation 0 Removal Date Place Removed and/or and/or Held F- Hold Address CD O. Date Point of (f)❑Transportation CI Common Shipment Carrier Destination Date Cemetery Address Disinterment EI 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 5 Address CC UJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/30/2024 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: I— Z Date of Disposition 21 5 I'Z y Place of Disposition FTVE‘+E0 if1E m, 1g u` ILI 2 (address) W NCC (section) /] (lot number)5.....„ (grave number) G/J a Name of Sexton or Person in Charge of Pr ' s r� Z please print) 1!1 Signature Title f DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#