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Loveland, Francis O
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Francis O. Loveland Male Date of Death Age If Veteran of U.S.Armed Forces, 10/09/2020 81 Years War or Dates 1957-1962 H Place of Death Hospital,Institution or W City,Town or Village Hadley Town Street Address 72 Stewart Bridge Road, Hadley Town, New York 12835 p Manner of Death ©Natural Cause 0 Accident 0 Homicide Ei Suicide ❑Undetermined ❑Pending W v Circumstances Investigation W Medical Certifier Name Title O George Siniapkin MD Address 604 Palmer Avenue,Corinth, New York 12822 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 14 ❑Burial Date Cemetery,Crematory or Facility Name 10/10/2020 Pine View Crematory 0 Entombment Address X❑Cremation Queensbury Town, New York ElDonation • ZO Ej Removal Date Place Removed and/or and/or Held F- Hold Address U) ' 0 CI. Date Point of U) ❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address 0 Disinterment Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/10/2020 Registrar of Vital Statistics 1' _1ineG9rt i(Elatraydly3gel (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 10 ip)70 Place of Disposition F ,Vi c W (address) mod' W U) (section) (lot number) (grave number) ir G Name of Sexton or Person in Charge of Pr ises d't t" � �;+ z e Z (plea e print) rQ�,,1-� W Signature _ L� Title b' " 'FI "it DOH-1555(o7/18)p 1 of 2 j 1 Public Health Law Sec. 4145(2b) L' Q.! 93 Receipt 1 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#