Lescault, Lucille NEW YORK STATE DEPARTMENT OF HEALTH �..;
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lucille A Lescault Female
:L Date of Death Age If Veteran of U.S. Armed Forces,
• 07/30/2018 75 Years War or Dates
ry' Place of Death ` Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death a Natural Cause O Accident O Homicide O Suicide El O Undetermined O Pending
Circumstances Investigation
Medical Certifier Name Title
Roshan Asrani MD
Address
43 New Scotland Ave,Albany,New York 12208
• Death Certificate Filed District Number Register Number
• City, Town or Village Albany 0101 1677
OBurial Date Cemetery or Crematory
08/01/2018 Pineview Crematory
.OEntombment Address
., ®Cremation Queensbury Town, New York
4'4.,' Date Place Removed
°"El O Removal
and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
( by Common Destination
Carrier
O Disinterment
Date Cemetery Address
ri
O Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
• Address
� 7 Sherman Ave,Corinth,New York 12822
• 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.
• Date Issued 08/01/2018 Registrar of Vital Statistics oaniedes ciffe ie(ECectronicaltySigned)
(signature)
IA District Number 0101 Place Albany, New York
-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1131tf Place of Disposition ;wU,,,, �r,lti.---
i
; (address)
(section) (l umber) (grave number)
Iid
Name of Sexton or Person in Charge of Pre ises A1oL
4Y.g'1'
(please Mint)
g
- i Signature Title (It£1Th{
(over)
DOH-1555 (02/2004)