Loading...
Heym, Frederick Henry NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frederick Henry Heym Male Date of Death Age If Veteran of U.S.Armed Forces, 05/09/2021 80 Years War or Dates 1962-1966 F Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 34 Willowbrook Road 204,Queensbury Town,New York 12804 pManner of Death © Natural Cause El Accident ❑Homicide El Suicide DUndetermined D Pending W Circumstances Investigation W Medical Certifier Name Title Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 105 EiBurial Date Cemetery,Crematory or Facility Name 05/11/2021 Pine View Crematory Entombment Address lCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed O or and/or Held and/ COHold Address 0 O. Date Point of Cl) Li Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above 2 Address fr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/11/2021 Registrar of Vital Statistics Caroline ili&degaree Barber(Electronically Signed) (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 H * _ W Z Date of Disposition 3-III I Place of Disposition ' (address W CC (section) (lot number) c (grave number) 0 Name of Sexton or Person in Charge of Pr ises G t'r'^ `" t (pleas riot) Z W Signature Title ( `' Thv2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 4 77 5 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#