Fekeith Sr, Harvey NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
r, :, Name First Middle Last Sex
r r Harvey Richard Fekeith, Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
'::: February 17, 2015 66 War or Dates
V.:: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
1Manner of Death I XI Natural Cause I Accident Homicide Suicide Undetermined I 1 Pending
Circumstances Investigation
Medical Certifier Name Title
,. ; Dr M.Davidowitz,MD
,��,', Address
., 100 Park Street, Glens Falls,NY
r.1 Death Certificate Filed District Number Register Number
/�5
_. City Town or Village "i
,Y:, Y� 9 Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
February 20, 2015 Pine View Crematorium
❑Entombment Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I 1 Removal and/or Held
and/or Address
t_: Hold
Cl)
0 Date Point of
Cl. Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
K;1 Name of Funeral Home Regan Denny Stafford Funeral Home 01443
g Address
gii 53 Quaker Road, Queensbury, NY 12804
rg.:. Name of Funeral Firm Making Disposition or to Whom
Ik°+.:; Remains are Shipped, If Other than Above
Address
Permission is hereby g dispose to dis ose of the human r ains d cribed above as indica -d.
Date Issued e ( Registrar of Vital Statistics i G/2
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z f?JI.
i
w Date of Disposition "ZINIS- Place of Disposition
~
2 (address)
W
U)
CL (section) �(1 number) scer (grave number)
p Name of Sexton or Person in Charge of Premises Apr
ill-,
(pleasb print)
W Liv Title mii4 t
Signature ,. -
(over)
DOH-1555(02/2004)
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
i� 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.
a
Date Issued 9I ,z,$)IS Registrar of Vital Statistics � � ` 'l. IZ.,�.�,+ .
ff
(signature)
District Number S'-)SK, Place Cifil
tt 1 kit,
* I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 09/28/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number (grave number)
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