Lefebvre, Victor NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Victor Lefebvre Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/30/2021 92 Years War or Dates 1947-1952
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 80 Aviation Road,Queensbury Town, New York 12804
p Manner of Death 0Natural Cause ❑Accident ❑Homicide ❑Suicide `sEl Undetermined ❑Pending
UCircumstances Investigation
W Medical Certifier Name Title
0 Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 212
❑Burial Date Cemetery,Crematory or Facility Name
11/02/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
0 Donation
ZZ ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
Date Point of
• ❑
(/) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
g Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/01/2021 Registrar of Vital Statistics CarolinexIgardi Barber(Ekctronrcall:y 4/ne9
(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 on:
I—
Z Date of Disposition 04111 I1.1 Place of Disposition
2 (addr ss)
W
(section) / (lot number)I., (grave number)
t11
o Name of Sexton or Person in Charge of Premises ry L &Air
(please print) 1 �
W "'
Signature `' ` IA` Title fir" r}i
DOH-1555(07/18)p id 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral hpme named on burial permit
Official Funeral Directors Reg. or License# f''