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Lehecka, Elizabeth Ann NEW YORKSTATE DEPARTMENT OF HEALTH • Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth Anne Lehecka Female Date of Death Age If Veteran of U.S.Armed Forces, 08/21/2021 74 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W `p Manner of Death ❑X Natural Cause El AccidentHomicide Suicide Undetermined Pending U Circumstances Investigation 0 Medical Certifier Name Title Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 357 0 Burial Date Cemetery,Crematory or Facility Name 08/24/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury,New York ElDonation Z ❑Removal Date Place Removed H and/or and/or Held Hold Address 0 co 1-1 Transportation Date Point of Er) 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 (... Remains are Shipped,If Other than Above 2 Address CC LU 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/24/2021 Registrar of Vital Statistics Wp6ertf7n�rew Curtis.(/ctronica!!'Sign) (signature) District Number 5601 Place Glens Falls, 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 q—)_5_ Place of Disposition p;Ati /,e�� L(c,yrq �,(y 2 V (a dress) W CC (section) (lot number) (grave number) 0 Name of Sexton or Per in C rge of Premises Je.frr,z.)' Shy, (piebse print) W Signature Title 1 DOH-1555(07 )p t of 2 : 15071; Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery `,Representing the funeral home_.tialrted on burial permit Official Funeral Directors Reg.or License# 01 Oki Town of Queensbury Certification of Cremation Nliv3� Pine View Cemetery and Crematory This certifies that the remains of: Elizabeth Lehecka were cremated on August , 25 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death August 21 20 21 Age 74 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 705 (Aut orized Signature) LANG Owner Mary T.ang Address Plot 23 WoodstPar1 gd Ballston Lake, NY 12n19 Niche Wall Phone # Lot # 518-330-0383 Center B4 Deed # Date 17 10.6.23 Cost Foundation Y - N $1800.00 Location South-Batchelder West-Bartlett North-Ringer East-Bass Remarks L cina **- m(Irke. Y)1G�r 7j 1 Q1 J gMGAI L cicYm Record of Interments 1 S•ai a� c/; tQ_ 2 XL) Witt m t Lfh c ' l© lo° a7S 3 8 4 9 5 10 g a < > b. 1;WV- � N LEHECKA NAME Elizabeth LeHecka Age: 74 Lot Owner: Mary Lang Lot# NicheWall B4 Grave# B4 Case: Urn Died: 8.21 .21 Interred: 1 0. 6.23 Funeral Home: Baker FH Cemetery: Pine View