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Metzler, Kenneth J
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth J. Metzler Male Date of Death Age If Veteran of U.S.Armed Forces, 02/11/2024 64 Years War or Dates H. Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital IW p Manner of Death 0Natural Cause Accident 0 Homicide Suicide Undetermined ❑Pending C.) Circumstances Investigation W Medical Certifier Name Title i3 Vincent Cousineau Cote 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 90 Burial Date Cemetery,Crematory or Facility Name 02/16/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation OZ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 a Date Point of Cl) Transportation CI Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address III Reinterment 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 1— Remains are Shipped,If Other than Above 5 Address C W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/13/2024 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: Z Date of Disposition 7-I Zl I Z V) Place of Disposition C K-� C 11,),1C-tM A'-Pr°v , 2 (address) Ili U)CC (section) (lot number) (grave number) GName of Sexton or Person in Charge of Pr i `r` �- I' Z , (ple se print) ��,�� W Signature » Title tr4 J U DOH-1555(o7/18)p 1 of 2 ag s Public Health Law Sec. 4145(2b) . _� tip Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#