Tessier, Louis Ernest Jr. LF , )
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Louis Ernest Tessier Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/28/2022 93 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Lake George Town Street Address 34 Lower Hubbell Lane,Lake George Town,New York 12845
W Manner of Death Undetermined PendingEl
Cause Accident Homicide Suicide
W Circumstances Investigation
W Medical Certifier Name Title
G Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
DeaRth Certificate Filed Town Of Lake George District Number Register Number
City,Town or Village 5651 10
Burial Date Cemetery,Crematory or Facility Name
05/02/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
CO Transportation
p by 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
H Remains are Shipped,If Other than Above
5 Address
Q
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/02/2022 Registrar of Vital Statistics Patricia R lIc`Xinney-Sckuster(ECectronica(Cy Signed)
(signature)
District Number 5651 Place Town Of Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH 'Pa.—
�J
Z Date of Disposition 5131 j,Z Place of Disposition 1 ' .— .
UJ
2 (address)
W
N
CC (section) (lot number) c (grave number)
GName of Sexton or Person in Cha of Premises ��! f -�+' tt
Z /Tease print)
W Si nature Title Ow)A N � -
g J`
DOH-1555(07/18)p t of 2
u _ ? I f.
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on " , 20
11
s
Pine View Cemetery Representing the funeral homenamed on burial permit
Official Funeral Directors Reg.or License# -