Kehoe Jr., Francis L. NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Francis L.Kehoe Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/01/2020 80 Years War or Dates
f.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
ILI!p Manner of Death RI Natural Cause Accident Homicide Suicide Undetermined Pending
UCircumstances Investigation
QW Medical Certifier Name Title
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 35
Burial Date Cemetery,Crematory or Facility Name
03/03/2020 Pineview Crematory
Entombment Address
R]Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
(L Date Point of
(A ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
�_— Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/02/2020 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Hell
Z Date of Disposition 3 14 170 Place of Disposition J_
Uj (address)
W
N IX (section/ (tot number) (grave number)
ako"
0 Name of Sexton or Person in Charge of Premises t'i
Z 1. (pte a print)
W Signature (,yJ(f/ Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) y v
Receipt
Human remains of >`: delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#