Kineke, Francis NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
iv Name First Middle Last Sex
Francis Arthur Kineke Male
" Date of Death Age If Veteran of U.S. Armed Forces,
05/14/2018 83 Years War or Dates 1957-1963
AY
, Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death j Natural Cause 0 Accident Homicide 0 Suicide El Undetermined ri Pending
Circumstances Investigation
• Medical Certifier Name Title
i Suzanne Blood MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
4.1 City, Town or Village Glens Falls 5601 239
sal
❑Burial Date Cemetery or Crematory
05/16/2018 Pine View Crematory
;;❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
_, and/or Address
Hold
• 9 Date Point of
• Transportation Shipment
7- TM, by Common Destination
Carrier
iift T .Q Disinterment Date Cemetery Address
• Reinterment Date Cemetery Address
ve
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804 ID
PA Name of Funeral Firm Making Disposition or to Whom
it
Remains are Shipped, If Other than Above
Address
R"
Permission is hereby granted to dispose of the human remains described above as indicated.
pi Date Issued 05/16/2018 Registrar of Vital Statistics c p6ert f Curtis(Efectronicaffy Signed)
(signature)
PO
2.144.
District Number 5601 Place Glens Falls, New York
ilI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
L} Date of Disposition $ Ill I i g Place of Disposition f i..�4,,,f r tQri,+._
(address)
:
(section) /rot number) (grave number)
. Name of Sexton or Person in Charge of Premises i e '"A
tift-
(pleelse print)
/,
Signature VT c- Title riZ Ent ay_
(over)
DOH-1555 (02/2004)