Wheet, Kevin Case NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kevin Case Wheet Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/10/2021 36 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 41 Elizabeth Lane,Queensbury Town,New York 12804
W Manner of Death Undetermined Pending
W w Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
Paul Bachman MD
Address
3767 Main Street,Warrensburg Town,New York 12885
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 48
ElBurial Date Cemetery,Crematory or Facility Name
02/16/2021 Pine View Crematory
Entombment Address
gCremation Queensbury Town,New York
Donation
W ElRemoval Date Place Removed
and/or and/or Held
H N Hold Address
0
a- Date Point of
U) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
5 Address
W
a" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2021 Registrar of Vital Statistics Camlinexkfegard Bar6er(ElectronicafSigned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 2-1 Iq/zi Place of Disposition111
�..
2 (address)
W
CC CC (section) (lot numbe (grave number)
0 Name of Sexton or Person in Charge of Prem.
`1�•i��. t�!►l DY
(please print)
W Signature Title l 'ts-
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) ' .. .4 57
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# •