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Dunlap, Brian Robert . it, z3 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Brian Robert Dunlap Male Date of Death Age If Veteran of U.S.Armed Forces, 02/29/2024 75 Years War or Dates F., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 25 B Larose Street,Glens Falls,New York 12801 pManner of Death Natural Cause Accident Homicide El Suicide Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title C Marten Peterson MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number ,Town or Village Cie 5601 131 Burial Date Cemetery,Crematory or Facility Name 03/06/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York DDonation OZ❑Removal Date Place Removed and/or and/or Held I- - Hold Address f 0 O. Date Point of (/) Transportation Shipment p by Common Carrier Destination IDDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/06/2024 Registrar of Vital Statistics 91•fegat Wofin(E1 ctronicalfySigned) (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: Z W Date of Disposition 31 L I 21/41 Place of Disposition �id E41 i54j � �'P` l'y )('}�,1.� 2 (address) W it (section) (lot number) (grave number) g1,i V. at Name of Sexton or Person in Charge of Premis Z ease prin W Signature (- Title r 4MA1( DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) r` • ` '� Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#