Feulner, Kenneth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ti't Burial - Transit Permit
Name First Middle Last Sex
Kenneth C.Feulner Male
Date of Death Age If Veteran of U.S. Armed Forces,
08/15/2018 53 Years War or Dates
Place of Death Hospital, Institution or
- City, Town or Village Schenectady Street Address Ellis Hospital
➢.v. Manner of Death Undetermined Pending
Q Natural Cause Accident 0 Homicide �Suicide
Circumstances Investigation
• Medical Certifier Name Title
Niraj Sinha MD
Address
;- 1101 Nott St,Schenectady,New York 12308
Death Certificate Filed District Number Register Number
City, Town or Village Schenectady 4601 730
- ❑Burial Date Cemetery or Crematory
08/16/2018 Pineview Crematorium
❑Entombment Address
mow;®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or -Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
0 Disinterment
Date Cemetery Address
4fr.Y
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
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/16/2018 Registrar of Vital Statistics Charles'Wham Thorne(Electronica1TySigned)
(signature)
kiz District Number 4601 Place Schenectady, New York
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7 .) r I Place of Disposition p,,Ac j (),✓ ,rem;4',t`y(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises c.fr-eY S :RS
=3,
(please print)
Signature Title cr€M -tc.r
(over)
DOH-1555 (02/2004)