Steves, Wesley NEW w RK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
r Wesley Kirk Steves Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 1, 2013 59 War or Dates
I"' Place of Death Hospital, Institution or
1 ii ', Town or Village Glens Falls Street Address Glens Falls Hospital
1:3� IFanner of Death J Natural Cause El Ili Accident 0 Homicide 0 Suicide riUndetermined n Pending
Circumstances Investigation
IL I' Medical Certifier Name Title
Robert W Sponzo MD,
Address
102 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
itg--- Town or Village i %j s 6-6:0/ 4S'/.3
Burial Date Cemetery or Crematory
December 6, 2013 Pine View Cemetery
0 Entombment
<.,_ Address
❑C rem ation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z El Removal and/or Held
and/or Address
E Hold Pine View Cemetery
0 Date Point of
a,, El Transportation Shipment
0 by Common Destination
O Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
tli
!I Permission is hereby granted to dispose of the human remains descri . a>ov s i ed.
S/20 3 Registrar of Vital Statistics .�
Date Issued�� � 9� ��
(signature)
District Number Spa,/ Place 6k175FL/4 /(4 /)i0/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 1 2/7/1 3 Place of Disposition Pine ViPw Cemetery
(address)
111 Mohawk 1 6 6 2
Ct (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Connie L. Goedert
Z 0 (please print)
113 Signature Title Superintendent
(over)
DOH-1555 (02/2004)
STEMS
(S) Lot No. 166
Address Woodard St., Glens Falls, N.Y. ce No.
Owner Wesley Steves Plot Mohawk
•
Date 1/9/81
67 Superficial ft. @ $250.00
Location Bounded on the North by Vacant, East by Vacant, South by Hartman, West by goad
Corner Posts
Remarks
Deed No. (and changes) 1631
Payment Record Paid in full 1/9/81
TI � u F
5'8 - Lc,
�/-
Form No. 01
Record of Interments
Linda Steves (1/9/81 ) I S
2 Wesley Kirk Steves ( 12/6/13 ) 6
CHI C FFc r f. Sfcut.5 (),6 0. 11.a3 7
4 I i 8
ft�/9
.tl
k x
r
NAME STEVES, WESLEY KIRK
Age: 59
Cause: Natural
Lot Owner: Wesley Steves
Lot # 166 MOhawk
Grave # 2
Case # Concrete
Died: 1 2/1 /201 3
Interred: 1 2/6/201 3
Undertaker: Carleton