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LeCuyer, ALbert R Jr.
. 44 -111 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle .' Last Sex Albert R LeCuyer Jr tjr Male Date of Death Age If Veteran of U.S.Armed Forces, 12/06/2023 77 Years War or Dates 1965-70 1_, Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital O Manner of Death IZINatural Cause ❑Accident Homicide Suicide Undetermined ❑Pending Circumstances Investigation I�LI Medical Certifier Name Title O Dean Reali DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 694 Burial Date Cemetery,Crematory or Facility Name 12/08/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F- Hold Address 0 0 IL Date Point of fA llTransportation Shipment p by Common Carrier Destination O Disinterment Date Cemetery Address ElReinterment 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 Q W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2023 Registrar of Vital Statistics Dillon Moran(Electronically Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /Z-9 Zvz3 Place of Disposition P r`'le_ Lit .1) Cre-rrik t- 2 (address) W CC (section) of nu bell (grave number) � J SName of Sexton or Person in Charge Pre i /Z i/1p^/c Uii-6Ol Z (please print) IIJ Si nature �s I% Title O •e�i- g 1� P DOH-1555(07/18)p 1 of 2 11 r f.u;� 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#