Huntley, Lester NEW YORK STATE DEPARTMENT OF HEALTH. . / 107
Vital Records Section , Burial - Transit Permit
Name First Middle Last Sex
Lester Leonard Huntley Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 27, 2013 78 War or Dates
Place of Death Hospital, Institution or
-.1 City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Deathm
IL.i Natural Cause 0 Accident ❑ Homicide ❑ Suicide ❑ Undetermined 17❑ Pending
Circumstances Investigation
Medical Certifier Name Title
0' Maureen Hyland,
Address
9 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number RegistNumber
' City, Town or Village Fort Edward L j 2j T
❑Burial Date Cemetery or Crematory
March 4, 2013
❑Entombment Pine View Crematory
Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
ID Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
IllReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
;.= Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
A Permission is hereby granted to dispose of the human rem ins escribed aboveas indicated.
Date Issued o?c-c ,3 Registrar of Vital Statistics _
(signature)
District Number ;.S 25 Place /Z6y2—��
�<<A
J
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/04/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number (grave number)
1p
r Name of Sexton or Pers n in Charge f Premises itt:* 1„
(please print)
..k Signature L _ Title Ca;wworTJQ.
(over)
DOH-1555 (02/2004)