Westfall, Florent Franklin NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Fkxent Franklin Westfal Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/122022 85 Years War or Dates NavY
1,. Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 43 Cunningham Avenue,Glens Falls,New York 12801
p Manner of Death El Natu ral Cause ❑Accident El Homicide OSuicide FlUndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G David Cunningham MD
Address
3 hung:its Center,Glens Falls,New York 12801
Death Certificate Filed city omens Fats District Number Register Number
C ,Town or Village 5601 314
Burial Date I Cemetery,Crematory or Facility Name
_ 06/182022 Pine View cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
NHold Address
0
l3. Date Point of
to Transportation Shipment
by Common
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queenebury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
5 Address
W
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/14/2022 Registrar of Vital Statistics Afigan9ite tt(°EYictmt SO4
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Ln- I B.-a Place of Disposition (;)j /.cam KC e sic icy N y 0;0q
(address)
w 11V C. 5
to (sedan) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises (please print)
W ;/1 -fie,7�enl:
Signature 46414
e ; Title Le r
DOH 1555(o7/18)pi of 2
Public Health Law Sec. 4145(2b) 012926
Receipt
Human remains of delivered on , 20
Pine View Cemetery—"` Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
WESTFALL
NAME Florent Franklin Westfall Age: 85
Lot Owner: Florenct & Mary Ann Westfall
Lot# Erie 54 D Grave# 3
Case: Concrete
Died: 6.1 2.2 2 Interred: 6. 1 8.2 2
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View
WESTFALL
Owner
Florent F. MD & Mary Anne Westfall
Address Plot
43 Cunningham AvA_ Gli2.ns Falls, NY 12801 Erie
Phone # Lot #
518-793-9318 54-D
Deed # Date
4145 9/10/2019
Cost Foundation Y - N
3000
Location
Bounded to the North by Lanfear/Tisinger, North by Ward
East by Duncan, South by Didora
Remarks
Record of Interments
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