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Lescault Jr., Daniel J
Sol NEW YORKSTATE DEPARTMENT OF HEALTH • / Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel J Lescault Jr Male Date of Death Age If Veteran of US.Armed Forces, 06/18/2023 60 Years War or Dates 1982-86 �.., Place of Death Hospital,Institution or WCity,Town or Village Troy Street Address Samaritan Hospital 1p Manner of Death Z Natural Cause ❑Accident ri Homicide Duicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title 0 Michael Ciccarelli DO Address 2215 Burdett Ave,Troy,New York 12180 Death Certificate Filed City Of Troy District Number Register Number City,Town or Village 4102 328 Burial Date Cemetery,Crematory or Facility Name 06/21/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York EiDonation Z Removal❑ Date Place Removed and/or and/or Held Hold Address N 0 I- Date Point of (I)❑Transportation a by Common Shipment Carrier Destination ODisinterment Date Cemetery Address 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 F. Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/20/2023 Registrar of Vital Statistics Heather L Mulinio(Electronically Signed) (signature) District Number 4102 Place City Of Troy I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 W Date of Disposition (p�21�� Place of Disposition ,�L address) W CC N /sedbn) I (lot number) (grave number) aName of Sexton or Person in Charge miles /" Z lease print) IJV Signature Title �I 491 DOH-1555(07/18)p i of 2 017 13 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#