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Senecal , Thomas J. Sr. g. A. A 1 e 2 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas J Senecal Sr Male Date of Death Age If Veteran of US.Armed Forces, 02/14/2023 94 Years War or Dates 1950-52 F. Place of Death Hospital,Institution or W City,Town or Village Moreau Town Street Address 81 Lamplighter Acres, Moreau Town, New York 12828 O Manner of Death El Natural Cause ❑Accident 0 Homicide OSuicide FlUndetermined {]Pending W U Circumstances f 'Investigation W Medical Certifier Name Title O Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 8 Burial Date Cemetery,Crematory or Facility Name IIIIOf 02/16/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation ZO❑Removal Date Place Removed and/or and/or Held F Hold Address N 0 Date Point of N LTransportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2023 Registrar of Vital Statistics Leeann McCabe(Electronically Signed) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ?_Al (�-'t -- W Date of Disposition Z(I 23 Place of Disposition _ 2 (address) W to CC ,(section) flotnumberl (grave number) gName of Sexton or Person in Charge o Premises AIL_ rt z please print W (171c6)1 Siinature Title DOH-1555(07/18)p 1 of 2 -11 r. 71 1 .. 0 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#