Loading...
Loretto, Kevin Ft NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex r Kevin R. Loretto Male V Date of Death Age If Veteran of U.S. Armed Forces, r 01/23/2018 66 War or Dates n/a Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address 4 Queens Lane Manner of Death I x I Natural Cause I j Accident Homicide I- Suicide Undetermined 1 Pending I Circumstances Investigation Medical Certifier Name Title Ageel A. Gallonie, MD Address 102 Park Street Glens Falls New York r.,� Death Certificate Filed District Number Register Number ,':J City, Town or Village 01/25/2018 ❑Burial Date Cemetery or Crematory 01/25/2018 Pine View Crematory ❑Entombment Address b]Cremation _ Date Place Removed ZZ I I Removal and/or Held and/or Address F Hold W 0 Date Point of 3 I I Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address r' Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter 01596 ref te Address ,r, 407 Bay Road Queensbury, NY 12804 f,r Name of Funeral Firm Making Disposition or to Whom 1r Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. 4'rr 42.0,d-k.. �. AlC(14 4,;;; Date Issued t -a•5 -a+d I Registrar of Vital Statistics `r{ (signature) District Number ki,51 Place V ce►'1 S In u ri I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-. W Date of Disposition /-1-- -/Q'i Place of Disposition i;L1 L ire9 J Cre-rnci,,,y g; (address) WCO © (section) \ /(lot number) (grave number) Q Name of Sexton o Per on in Charge of Premises J IA-/%u-✓! 6 a,-4 4 Z (please print) uJ Signature s �_ Title 6--rem ''' (over) DOH-1555(02/2004)