Flewelling Sr., Stanley NEW YORK STATE DEPARTMENT OF HEALTH 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Stanley Leroy Flewelling Sr. Male
t Date of Death Age If Veteran of U.S.Armed Forces,
i = 04/27/2018 77 Years War or Dates 1959-1965
Place of Death Hospital, Institution or
- City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death J Natural Cause Ei Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
Circumstances Investigation
Medical Certifier Name Title
Jennifer Hayes MD
t Address
i-t 4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
2 City, Town or Village Argyle 5750 9
vDBurial Date Cemetery or Crematory
`
ri 04/30/2018 Pine View Crematory
❑Entombment Address
di
®Cremation Queensbury Town, New York
it
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
a by Common Destination
14 Carrier
517.4 Q Disinterment
Date Cemetery Address
El Reinterment Date Cemetery Address
j
Permit Issued to Registration Number
q Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
i l Address
ilk 123 Main St,Argyle,New York 12809
r; Name of Funeral Firm Making Disposition or to Whom
ti Remains are Shipped, If Other than Above
• Address
i>
FPermission is hereby granted to dispose of the human remains described above as indicated.
g
r Date Issued 04/30/2018 Registrar of Vital Statistics Slielley911ckemon(ECectronicallySigned)
141, (signature)
District Number 5750 Place Argyle, New York
1
1, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Chit'1 Place of Disposition .Pu(i-.0 �r-.---
(address)
t
2 (section) plot number) r�-- (grave number)
Name of Sexton or Person in Charge of Premises (/Ni - -.l1�.,,a61
4 (pie se print)
Signature 1 Title neEavtNii-
(over)
DOH-1555(02/2004)