Wimette, Kenneth •
NEW YORK STATE DEPARTMENT OF HEALTH It 773
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kenneth E. Wimette Ma1P
. Date of Death Age If Veteran of U.S. Armed Forces,
1 0/29/201 5 76 War or Dates 1 958-1 962
w-• Place of Death Hospital, Institution or
ZCity, Town or Village Long Lake Street Address
O Manner of Death a Natural Cause 0 Accident El Homicide ❑Suicide riUndetermined D Pending
ILI Circumstances Investigation
W Medical Certifier Name Title
O Virginia Jennings Coroner
Address .
P.O.Box 7 T,ong Lak.P, NY1 2847
Death Certificate Filed District Number Register Number
City, Town or Village Long Lake
0Burial Date Cemetery or Crematory
11 /02/2015 Pine View Crematorium
DEntoinbment Address
®Cremation 21 Quaker Rd. Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2❑and/or Address
H Hold
O Date Point of
k0 Transportation Shipment
p by Common Destination
Carrier
0 Disinterment Date Cemetery Address •
❑.Reinterment Date Cemetery Address
Permit Issued to MB Kilmer FH Registration Number
Name of Funeral Home 01078
Address
136 Main St. SouthGlens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
} Remains are Shipped, If Other than Above
' Address
IX
LU
Permission is hereby granted to dispose of the human ains described above as 'ndicated.
Date Issued !/ Da-c2b/5 �Registrar of Vital Statistics r —
/ (signature)
District Number 0/0 Place
'.- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ll Date of Disposition li f cl is Place of Disposition g.,V.,..,) CrwKix,,.-
2 (address)
Lit
CC (section) / (lot number (grave number)
aName of Sexton or Person in Ch ge of Premises �- y
Z dr i (please print)
Signature Title tie -
(over)
•
DOH-1555 (02/2004) .