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Helms, Joseph A
r # sC/ NEW YORK STATE DEPARTMENT OF HEALTHel) Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph A Helms Male Date of Death Age If Veteran of U.S.Armed Forces, 07/07/2023 53 Years War or Dates E Place of Death Hospital,Institution or 111 Z City,Town or Village Newcomb Town Street Address 291 Campsite Road, Newcomb Town, New York 12852 p Manner of Death []Natural Cause []Accident []Homicide Suicide Undetermined ❑Pending W U I 1 Circumstances Investigation a Medical Certifier Name Title Kellie Valentine Coroner Address PO Box 132,Elizabethtown Town,New York 12932 / Death Certificate Filed Town Of Newcomb District Number Register Number City,Town or Village 1559 1-23 BurialH Date Cemetery,Crematory or Facility/Name 07/12/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0• Removal Date Place Removed H and/or and/or Held N Hold Address 0 CL CO❑Transportation Date Point of faby Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address []Reinterment Permit Issued to Registration Number Name of Funeral Home Edward L Kelly Funeral Home 00519 Address PO Box 548,Schroon Lake,New York 12870 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC uJ EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/11/2023 Registrar of Vital Statistics Mary 'ound Eketronicall;Signed (signature) District Number 1559 Place Town Of Newcomb I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H WDate of Disposition Place of Dispositiontr.':ti_ 7. 717.---_ 2 (address) N ))13173 CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pr ises �^ � Klf Z (pte se print) W Signature Title `poil DOH-1555(07/18)p 1 of 2 i o Public Health Law Sec. 4145(2b) „' Receipt Human remains of delivered on _ , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#