Loading...
Levesque, Cecile —� ,37 NEW YORK STATE DEPARTMENT OF HEALT*I c s? Vital Records Section Burial - Transit Permit Name First Middle Last Sex Cecile Levesque Female Date of Death Age If Veteran of U.S. Armed Forces, 03/25/2016 85 years War or Dates 1- Place of Death Hospital, Institution or X City, TYr)0@f ( Glens Falls Street Address Glens Falls Hospital a Manner of Death Natural Cause 0 Accident El Homicide 0 Suicide El Undetermined 0 Pending lE Circumstances Investigation til Medical Certifier Name Title 1 William Cleaver Attending Physician Address 100 Park St Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, TXaX#ArXXi Glens Falls 5601 163 <« ❑Burial Date Cemetery or Crematory 03/28/2016 Pine View Crematorium ['Entombment Address ©Cremation Queensbury, NY 12804 Date Place Removed Z Removal and/or Held Q and/or Address F Hold t13 Date Point of tiii❑Transportation Shipment L' by Common Destination mi Carrier Disinterment Date Cemetery Address a ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Edward L. Kelly Funeral Home 00519 Address Schroon Lake, N Y 12870 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Ix Ili CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/28/2016 Registrar of Vital Statistics I} ‘t W—^.; (sig ature) lii District Number 5601 Place Glens Falls N v • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ul Date of Disposition 3/30 fii, Place of Disposition K,V„.„ a (address) W t/ cc (section) A (lot number) (grave number) Name of Sexton or Person in Charge of Premises 4,41771. & z / (Pease print) # Signatures '/ Title ''` �I°L (over) DOH-1555 (02/2004)