Kenyon, Londa NEW YORK STATE DEPARTMENT OF HEALTH ' 4 gt j'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Londa D. Kenyon Female
: Date of Death Age If Veteran of U.S. Armed Forces,
s October 24,2018 73 War or Dates
1' _ Place of Death Hospital, Institution or
Z. City, Town or Village Johnsburg Street Address 55 Ridge St.
LU
Manner of Death X Natural Cause 1 'Accident Homicide Suicide Undetermined Pending
W, Circumstances Investigation
W Medical Certifier Name Title
P. James Hindson MD
Address
Main St.,Warrensburg,NY 12885
Death Certificate Filed District Number Registel Dumber
t
City, Town or Village Johnsburg 5655 '
❑Burial Date Cemetery or Crematory
October 26,2018 Pine View Crematory
❑Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F" Hold
N
O Date Point of
1 I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
•
Reinterment Date . Cemetery Address
'1 Permit Issued to Registration Number
Name of Funeral Home Alexander. .. ker Funeral Home 00037
Address
3809 Main Street, Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
1 Address
M.
w
rz. Permission is hereby granted to dispose of the human remai s scribed above as i dicated
Date Issued 10/25/18 Registrar of Vital Statistics , {. (. C, r
(signature)
District Number 5655 Place Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
WDate of Disposition lb !illy' Place of Disposition a0,.,,,, t/4.cio..,,..,J
E (address)
W
cn
ce (section) (lot num r) (grave number)
Q Name of Sexton or Person in Charge of Premiss i r+i St 1.1 t
IZ (please print)
Signature Title 1-1*(4n Ort,
(over)
DOH-1555 (02/2004)