Lescault, Kimberly 2S
NEW YORK STATE DEPARTMENT OF HE A H
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kimberly M Lescault Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/23/2018 44 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Deathow ITANatural Cause Accident Homicide Suicide El❑ Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Enrico Bravo MD
Address
vti 211 Church St,Saratoga Springs, New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 615
❑Burial Date Cemetery or Crematory
_ 11/26/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500, Lake Luzerne, New York 12846
l 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 11/25/2018 Registrar of Vital Statistics John Eranck(E(ectronical(y Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition fl—fir)_i? Place of Disposition fi,w {,w Cif e,P1(1-1-o`Y
(address)
;tom
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises e,Crot,Y Sep irc,5
(please print)
Signature Title C.f�ime7- '°r
(over)
DOH-1555 (02/2004)