Parsons, Louie NEW Yt)RK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Louie Parsons Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 21, 2013 79 War or Dates
E, Place of Death Hospital, Institution or
Z City, Town or Village Street Address
Manner of Death I X'Natural Cause El Accident n Homicide ^Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Ci John Stoutenburg
Address
102 Park Street, Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Moreau 4562
El Burial Date Cemetery or Crematory
❑Entombment December 26, 2013 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, ,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
NF" Hold
0 Date Point of
n Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I`- Remains are Shipped, If Other than Above
2 Address
Ct
a
Permission is hereby granted to dispose of the human remains escribed above as jpdicated.
Date Issued /a 4.4G".5 Registrar of Vital Statistics remains
(mature)
District Number 4562 Place Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1 2/21 /1 3 Place of Disposition Pine VIew Cemetery
V,I (address)
Mohican 75 B 2
QGl (section) (lot number) (grave number)
Name of Sexton or Person in C e of Premises Connie L. Goedert
(please print)
W Signature 12 ( Title Superintendent
(over)
DOH-1555(02/2004)