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Allen Sr., Lehman O
• 0649 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lehman O.Allen Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 10/10/2021 85 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing ci W Manner of Death ©Natural Cause ❑Accident ❑Homicide Ej Suicide Undetermined El Pending UCircumstances Investigation uJ Medical Certifier Name Title CI Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 84 ❑Burial Date Cemetery,Crematory or Facility Name 10/12/2021 Pine View Crematory 0 Entombment Address Cremation Queensbury Town,New York 0 Donation ElRemoval Date Place Removed and/or and/or Held Hold Address 0 a Date Point of ❑ U) Transportation p by Common Shipment 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 H Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/12/2021 Registrar of Vital Statistics Jenny Linda M Martelle(Electronically Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition /p_13.2t 121 Place of Disposition Lim .. lw �hp��e,Y✓ 2 (address) W N re (section) (lot number) (grave number) 0 Name of Sexton or Pers i Charge of Premises i F...ri t ri e (please print) W Signature Title ✓),1 it, Dipeca DOH-1555(07/18)p t 2 A i 1 Public Health Law Sec. 4145(2b) 1 1 Receipt 1 1 Human remains of i delivered on is- , 20 V 1 / 1 Ptfie View Cemetery Representing the funeral home named on burial permit 1 "f Official Funeral Directors Reg.or License# ,