Loading...
Sternin, Lester -4t--(i,-5-- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section x Burial - Transit Permit Name First Middle Last Sex Lester Sternin Male Date of Death Age If Veteran of U.S. Armed Forces, November 30, 2012 WI War or Dates Place of Death Hospital, Institution or • City, Town or Village Minerva Street Address 2873 St. 28N US es Manner of Death X Natural Cause n Accident Homicide Suicide —Undetermined Pending MI Circumstances Investigation Medical Certifier ame Title 1Vdress Death Certificate Filed i District Number Register Number City, Town or Village Minerva,NY ❑Burial Date Cemetery or Crematory December 4, 2012 Pine View Crematorium ❑Entombment Address ©Cremation 21 Quaker Road, Queensbury,NY 12804 Date Place Removed Z n Removal and/or Held C and/or Address H Hold N O Date Point of u) Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address �.; Permit Issued to Registration Number Name of Funeral Home Regan & Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address te W. .1 , Permission is hereby granted to dispose of the human ains described above as indicated. Date Issued 1 -\� 1}`ao CD- Registrar of Vital Statistics *-c.A. (signature) District Number \ Gj 1 Place Minerva,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition j2•5-11 Place of Disposition eaUcu-• Cre4ot'v4— i (address) W CO CL 0 (section) A . (lot number) (grave number) pName of Sexton or Person in Ch rge of Premises /11 t') tc l,t- t»*G'- Z (please print) W Signature Title CQ,011 pr-t (over) DOH-1555(02/2004)