Meimann, Kenneth Harold NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kenneth Harold Meimann Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/30/2023 91 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
pManner of Death ❑X Natural Cause Accident ❑Homicide 11]Suicide Undetermined Pending
Circumstances Investigation
G Medical Certifier Name Title
John Quaresima MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 15
X Burial Date Cemetery,Crematory or Facility Name
02/02/2023 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
DDonation ,
ZO❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
O. Date Point of
(/)OTransportation
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
f.. Remains are Shipped,If Other than Above
a Address
It
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/31/2023 Registrar of Vital Statistics Aimee L Mahoney(ECectronicaC( Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition O. a-(D3 Place of Disposition a\ QL`\.1, , R-c) FRS rl . 3 1Dtp4.
UJ
2 (address)
u, erRle 551-I I
CA
(section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises
Z (please print)
W Signature 4.4.4-4. e 5 Title �) ►-')E=..c:21 n C ..ktik.
DOH-1555(07/18)p 1 of 2
Public Health Law Sec.4145(2b) 6 7
u 296
Receipt
Human remains of `:t 'r 1 J `' '-'/ fl delivered on f , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
MEIMANN
NAME Kenneth H Meimann Age: 91 LE :
Lot Owner: Kenneth H Meimann/MArk Biagi
Lot# Erie 55H Grave# 1
Case: Concrete
Died: 1 .3 0.2 3 Interred:2,2 ,2 3
Funeral Home: Baker FH
Cemetery: Pine View
MEIMANN/BIAGI
i
Owner
Kenneth H. Meimann/ Mark Biagi
Address Plot
319 Broadway FT Edwars, NY 12828 Ft Hudson Nursing Erie
Phone # Lot #
520-509-1920 Son-Mark 55H
Deed # Date
4292 10.28.21
Cost Foundation Y - N
$650.00
Location West-Road
East-Palmer
South-Wicks
North-Certain
Remarks
lca _L LrtYic
Record of Interments 60,._
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