Flint, Lester ,NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lester Flint male
Date of Death Age If Veteran of U.S. Armed Forces,
11/20/1998 92 War or Dates n/a
Place of Death Hospital, Institution or
City,X66 M)6KXlXIXAA Glens Falls Street Address Glens Falls Hospital
Manner of Death Fx7,Natural Cause Accident Homicide Suicide ❑ Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
B. Villajuan, MD
Address
90 South Street, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,XOMXNKXIi(t )k Glens Falls 5601
Date Cemetery or Crematory
Burial 11/23/1998 Pine View Crematory
Address
<: ®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
0❑Removal and/or Held
•• and/or Address
Hold
Q Date Point of
NQ Transportation [Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01565
Address
53 Quaker Road, Queensbury, NY 12804
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 descr'ged a ov s i is to .
Date Issued egistrar of Vital Statistics G/
(signature)
District Numbe o� Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Place of Disposition A1 A�U �GJ �i
W- (address)
Uj
N
>> (section) Q n �(lo nu er (grave number)
0Name of Sexton or Person in Charge of Premises
g (please print)
Signature ," Title �' /� Le
(over)
DOH-1555 (9/98)