Lewandowski, Eleanor V. Bureau of Vital Records
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Name First Middle Last Sex
Eleanor V.Lewandowski Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/08/2021 95 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Lake Luzerne Town Street Address 40 Sylvan Road, Lake Luzerne Town, New York 12846
W
Manner of Death Natural Cause 0 Accident ❑Homicide El SuicideUndetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
Amy Johnson PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Lake Luzerne 5656 14
❑Burial Date Cemetery,Crematory or Facility Name
10/08/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
0 Donation
Removal Date Place Removed
and/or and/or Held
~
N Hold Address
0
d 1-1 Date Point of
f/) ❑Transportation Shipment
p by Common
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500, Lake Luzerne,New York 12846
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
5 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/08/2021 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed)
(signature)
District Number 5656 Place Lake Luzerne, 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 /2.9-:102 Place of Disposition t1 i-ert) C/'1e moj.
W (address)
W
CCCC (section) (lot number) (grave number)
Name of Sexton or Person in Char of Premises „ �`��°'�� Goo.
(please print)
W Signature a .7I a` Title efe
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