Loading...
Keech, Jean NEW YORK STATE DEPARTMENT OF HEALTH LOF Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Female Jean Keech Date of Death Age If Veteran of U.S.Armed Forces, 12/12/2020 88 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Oppenheim Town Street Address 218 Keyser Lake Rd,Oppenheim Town,New York 13329 IJJ 0 Manner of Death © Natural Cause El Accident El Homicide El Suicide 0 Undetermined El Pending W Circumstances Investigation V Title W Medical Certifier Name O Kevin Cope MD Address 4988 State Highway 30,Amsterdam Town,New York 12010 Death Certificate Filed District Number Register Number City,Town or Village St.Johnsville 1757 007 ©Burial Date Cemetery,Crematory or Facility Name 12/16/2020 Pine View Cemetery ElEntombment Address ❑Cremation Queensbury Town,New York EjDonation OD Removal Date Place Removed and/or and/or Held NQ Hold Address a Date Point of N ❑Transportation Shipment b by Common Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Z Address Q IW O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/15/2020 Registrar of Vital Statistics G(ona 9 Brys(E(ectronically Signed) (signature) District Number 1757 Place St.Johnsville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/16/202®laceofDisposition 21 QuakPr Rd QuPp asSbu/y, NY 12804 WSeneca 32-D 1 MCC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises Connie Goedert ,pp (please print) W Signature It-/u.2 h,_ A 6 'y1 ' % Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012829 Receipt Human remains of t delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# KEECH NAME Jean Keech Age: 88 Lot Owner: Jean Keech Lot#Seneca 32-D Grave#• 1 Case: Concrete Died: 1 2/1 2/2 0 2 0 Interred:1 2/1 6/2 0 2 0 Funeral Home: Regan Denny Stafford FH Cemetery: Pine View