Viele, Lillian NEW YORK STATE DEPARTMENT OF HEALTH t 6g
Vital Records Section x. Burial - Transit er �t
Name First Middle Last Sex
Lillian E. Viele Female
Date of Death Age If Veteran of U.S. Armed Forces,
09/12/2017 88 years War or Dates
1.- Place of Death Hospital, Institution or
O EXX wn or VX X Granville Street Address Haynes House Of Hope
lia
a Manner of Death❑,ddatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
11.1 Circumstances Investigation
W Medical Certifier Name Title
a Mark Hanson R P A-C
Address
13 Palmer Ave, Corinth, New York 12822
Death Certificate Filed District Number Register Number
OftWown or VItagiSX Granville 5756 38
❑Burial Date Cemetery or Crematory
09/14/2017 Pine View Crematory
I['Entombment Address
❑Cremation Queensbury, N Y
Date Place Removed
2.❑Removal and/or Held
and/or Address
CO
Hold
0 Date Point of
EL t ❑Transportation Shipment
0 by Common Destination
Carrier
M ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
75 Sherman Ave, Corinth, Ny 12822
Name of Funeral Firm Making Disposition or to Whom
I-- Remains are Shipped, If Other than Above
Address
I
Ui
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/13/2017 Registrar of Vital Statistics i uj
(si nature)
District Number 5756 Place Granville
lH I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z a,
alDate of Disposition 1II ((1 Place of Disposition ?.iL.. 1irryw.vtoriv„
2 (address)
W
CO
CC (section) /(lot number) c (grave number)
raName of Sexton or Person in Charge of Premises /ittir ✓(�41�
/I� (ple e print)
ELI Signature w` Title atranATIAL
(over)
DOH-1555 (02/2004)