Loading...
Hornbeck, Peter L. N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peter L Hombeck Male Date of Death Age If Veteran of U.S.Armed Forces, 12/26/2020 77 Years War or Dates 1966-1967 H Place of Death Hospital,Institution or WCity,Town or Village Minerva Town Street Address 141 Trout Brook Road, Minerva Town, New York 12857 Manner of Death © Natural Cause El Accident El Homicide ❑Suicide Undetermined El Pending C.) Circumstances Investigation CI Medical Certifier Name Title Kellie Valentine Coroner Address PO Box 132,Elizabethtown Town,New York 12932 Death Certificate Filed District Number Register Number City,Town or Village Olmstedville 1557 8 ElBurial Date Cemetery,Crematory or Facility Name 12/29/2020 Pine View Crematory El Entombment Address EiCremation Queensbury Town,Warren,New York Donation g ❑Removal Date Place Removed and/or and/or Held H N Hold Address 0 N ❑Transportation Date Point of p by Common Shipment Carrier Destination EI Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Edward L Kelly Funeral Home 00519 Address PO Box 548,Schroon Lake,New York 12870 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address CC a Permission is hereby granted to dispose of the human remains described above as indicted. Date Issued 12/28/2020 Registrar of Vital Statistics Diana Mason(ECectronicaCCySigned) (signature) District Number 1557 Place Olmstedville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition f�'�9'?OZp Place of Disposition �y� (address! W Q (section) // (lot number) (grave number) GName of Sexton or Per inCha a of Premises l (%wn L7 �CcCi�� /(please print) W Signature Title G 1 i,,,e, DOH-1555(07/18) t of 2 Public Health Law Sec. 4145(2b) 0 4.3 Receipt Human remains of delivered on , 20 Pine V7 -mete Representing the funeral home named on burial permit Officia" , Funeral Directors Reg.or License#