Hawkins, Lester NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Mi Name First Middle Last I Sex
HAWK INS LESTER H MALE
ii Date of Death Age 1 If Veteran of U.S. Armed Forces,
04/lit/1998 77 v ears War or Dates
14 Place of Death Hospital, Institution or
Z City, Town or Village HALFMOON Street Address 54 KATHER I NE DRIVE
Manner of Death �h tural Cause 0 Accident ❑Homicide 0 Suicide 0 Undetermined ❑Pending
LU Circumstances Investigation
Medical Certifier Name Title
J. PASTON MD
Address
11 CHURCH STREET- SARATOGA SPRINGS 1E866
Ri Death Certificate Filed District Number Register Number
' ni City, Town or Village HALFMOON 4559 10
Date Cemetery or Crematory
:H ❑Burial 04/16/1998 PINE VIEW CREMATORIUM
Address
❑6remation OUEENSBURY, NY
' 1 Date I Place Removed
Removal I and/or Held
and/or Address
C- Hold
Q Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
` Name of Funeral Home W I LL I AM J. BURKE & SONS FUNERAL 00269
gi
::]i:::i Address
628 NORTH BROADWAY SARATOGA SPRINGS, NY 1286,6
Name of Funeral Firm Making Disposition or to Whom
P'"' Remains are Shipped, If Other than Above
Address
LU
a
€€<s Permission is hereby granted to dispose of the human - I ains d • • - above as indicated.
ni Date Issued 04/16/l 998Registrar of Vital Statisti j ' ' / `�All'1 - J
(si. :ture)
iiiiiiii District Number +5 5 9 Place HALFMOON
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Lij Date of Disposition < /�' Place of Disposition J2/ /y.� �1,f- G�i�/14/9/���CJkl
2 / (address)
Ui
U3
IX (section) Q (lot numbe (grave number)
GName of Sexton or Person in Charge of Premises i�.P!/07R,P /4i9'TX/Y
Z - (please print)4.4 ��.- -� �!
Signature gA $JJ\ Title_ ,�/f/1/972fR 7cS5f 1
DOH-1555 (10/89) p. 1 of 2 VS-61