Strenkowski, Raymond Natalius NEW YORK STATE DEPARTMENT OF HEALTH _ Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Raymond Natalius Strenkowski Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/06/2023 80 Years War or Dates
f• Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death II Natural Cause Accident El Homicide []Suicide nUndetermined ❑Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
0 David Cunningham MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 14
X Burial
M Date Cemetery,Crematory or Facility Name
01/13/2023 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
Q. Date Point of
U) Transportation Shipment
Esby Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped,If Other than Above
i Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/10/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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:
l- l�
W Date of Disposition \,�3-�3 Place of Disposition 62\ l 9l c''.e j Vs , no) ��X1 L,►h.� l a, (
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cr (seetol (lot number) (grave number)
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G Name of Sexton or Person in Charge of Premises (please print)
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Signature ,
t
DOH-1555(018)p 1 of 2
Public Health Law Sec. 4145(2b) 012964
Receipt
•
Human remains of _ ; 20
delivered on ,
> 1 •
Pin ' iew Cemetery Representing the funeral home named on burial permit
cial Funeral Directors Reg.or License# -
STRENKOWSKI
NAME Raymond N Strenkowski f___._ Age 80
Lot Owner: Joan Strenkowski
Lot# Cayuga #1 j-1 3 Grave# 1
Case: Concrete
Died: 1 .6.2 3 Interred:1 . 1 3.2 3
Funeral Home: M.B. Kilmer FH
Cemetery: Pine View
ya! t
Strenkowski
Owner
Joan Strenkowski yy�
Address Plot
17 Congdon Rd. South Glens Falls, NY 12803 Cayuga #1
Phone # Lot #
518-796-3444 j -13
Deed # Date
4364 1 .9.23
Cost Foundation Y - N
$800 .00
Location West-Road
East-vacant
North-Vacant
south-Path
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: `` 1`/4-e4!.✓«t ;- DATE: < y ^m
SIGNATURE: DATE:
Record of Interments
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