Loading...
Dykeman, Van E. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Van E Dykeman I Male Date of Death Age If Veteran of U.S.Armed Forces, 05/02/2020 82 Years War or Dates 1956-1958 Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing pManner of Death © Natural Cause 1:1Accident Homicide Suicide Undetermined Ej Pending W Circumstances Investigation W Medical Certifier Name Title Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 25 Burial Date Cemetery,Crematory or Facility Name 05/04/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation z Removal Date Place Removed Pand/or I and/or Held 965 Hold Address a Date Point of U) ❑Transportation Shipment a by Common Carrier Destination Disinterment Date Cemetery Address -JReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom II— Remains are Shipped,If Other than Above 2 Address Q W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/04/2020 Registrar of Vital Statistics ,jenny Linda dartefCe(ECectronicafCy Signed (signature/ District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition S•Lf-'LO -0 Place of Disposition //;I 4L U X.'/ C=�e`►'c u" O�y�c�� l ./� �C Uj (address/ W (section) / (lot number) / (grave number/ O Name of Sexton or Person in Ch Pre ses t,t 1 r G�.G C�4k-,wL c—cv (please print) / W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) - � Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on,burial permit Official Funeral Directors Reg.or License#