Veysey, Wesley Cliff (2) eitoq
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Wesley Cliff Veysey Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/11/2021 70 Years War or Dates
1.,. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 110 Sagamore Street Apt.C, Glens Falls, New York 12801
Manner of Death Undetermined Pending
O �Natural Cause �Accident El El
W Circumstances Investigation
U
lu Medical Certifier Name Title
O Lisa Greenwald NP
Address
3 Irongate Center,Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 450
Burial Date Cemetery,Crematory or Facility Name
10/14/2021 Pine View Crematory
Entombment Address
EiCremation Queensbury Town,New York
Donation
O 0 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
0. Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Date Cemetery Address
❑Reinterment
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
IF- Remains are Shipped,If Other than Above
g Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/13/2021 Registrar of Vital Statistics poet_lndrew Curtis( ctronrca4Signed
(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:
IH
WDate of Disposition /D_is.zaLJ Place of Disposition P, v j,�,,) 6 ci437
2 (address)
W
CC CC (section) [lot number) (grave number)
Name of Sexton or Person' Charge of Premises i._.l i V1 G a` -4G4e
(please print)
W Signature G'Yj- Title vri y
DOH-1555(07/18)p t of 2
1
I
' Public Health Law Sec. 4145(2b)"�_.
1 Receipt
1 Human remains of i delivered on , 20
1
. 1 £
i ,Pine View Cemetery -Representing the funeral hortye named on burial permit
Official Funeral Directors Reg.or License# a
Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Wesley Cliff Veysey
were cremated on October 15 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death October 11 20 21 Age 70
(Month) (Day)
Funeral Home Baker Registered No. 864
(A orized Signature)
YEYSEY
Owner
Vicki 'Jeysev
Address Plot
61 McArthur Dr. Glens Falls, NY 12801 Seneca
Phone # Lot #
518-793-8307 5H
Deed # Date
4288 10/14/21
Cost Foundation Y - N
$650.00
LOCatiork est-Christoper
East-Ellsworth
North-Williams
South-Gates
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: J , DATE: /U Jj f
SIGNATURE: DATE:
Record of Interments
1 IAJ - la• IS- 91 6
2 7
3 8
4 9
5 10
Wit1;orns
l
J
s
s w t >E
c N S
Q
.F)
Veysey
NAME Wesley Veysey Age: 70 \
Lot Owner: Vicki\eysey
Lot# Seneca 5H Grave#1
Case: Urn
Died: 1 0 . 1 1 .21 . . . Interred: 1 0. 1 8.21
Funeral Home: Baker FH
Cemetery: Pine View