Kennison Sr., Chester NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last i, Sex
nm Chester M. Kennison Sr Male
Date of Death ? Age If Veteran of U.S.Armed Forces,
ik, • J ne...._7 19.8.7 58. ; WarorDates World War I I
Place of Death Hospital, Institution or
lw _Qity,_Town or Village G.1 e n 5,,..Fa1. 1.s Address G l e n s F a 1 1 s H o.s i t a 1.:,........:..........,........::.,.,........:.. Street
Cause of Death
W Septic check due to malig. melanoma
W Medical Certifier Name Title MD
Vincent J. Koh
Address
............._......._..__......._........_..................... 11
............ ............. .
428 Glen street, Glens Falls, N. Y. 12801
iiiiiiiir Death Certificate Filed District Number::...............................:............» Regiiister Number
City,Town or Village I ,56o / 0276
Date Cemetery or Crematory
❑Burial • June 10, 1987 Pine View Cemetery
. . ::.....
['Cremation
Address ....: :....:..:..:.... ..
Quaker Road , Queensbury , N . Y . 12801
z Date Place Removed ......::,
.0 ❑ Removal and/or Held
}. and/or Hold :....:.,.:::: :.,..,..:::::::.:. .:..,....::.:::......:...:..:...:::....:::..,:..:....;>..:.....:::...:. :...................................................................................................................
,N
0. Date Point of.. .
Cl)' ❑Transportation by Shipment
0 Common Carrier
Destination
El Disinterment
Date Cemetery Address
❑ Reinterment
Date Cemetery Address
Permit Issued to Registration Number
:::>:::
Name of Funeral Firm Re an & Denn Funeral Service , Inc 02883
:;:::> Address
Quaker Road.,___ Town of Queensbury N . Y . 12803
f„ Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
.......:::....:..:..............:............::.:......:....:..
. Address
:i>::
in Permission Is hereby granted to dispose of the dead an mains scribed above as indicated.
Date Issued 6 --y- ,,,-7 Registrar of Vital Statistic Q , etZ-
(sign re) ��
District Number 360/ Place _,1.z..--- G/
I certify that the remains of the decedent identified above were dispos in accordance with this permit on:
Z Date of Disposition Place of Disposition
2 (address)
W
CC (section) (lot number) (grave number)
pName of Secton or Person in Charge of Premises
z; (plea per)
ui
Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)