Lozowsky, Peter Alexander Sr. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peter Alexander Lozowsky Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/29/2024 93 Years War or Dates 1949-1953
H Place of Death Hospital,Institution or
W City,Town or Village Hudson Falls Village Street Address 14 Pine Street, Hudson Falls Village, New York 12839
W Manner of Death ZI Natural Cause Accident ❑Homicide Suicide Undetermined Pending
V I—ICircumstances Investigation
0 Medical Certifier Name Title
aAndrew Garner MD
Address
8 Harrison Harrison Avenue,Glens Falls,New York 12801
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 5
Burial Date Cemetery,Crematory or Facility Name
02/07/2024 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
g ElRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
0. Date Point of
Cl) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
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 01/31/2024 Registrar of Vital Statistics Cynthia ABardin(EtectronicaltySigned)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition c,�.-p L' Place of Disposition l L) ....jZ j i> j u.€ b , / 1 a` Oy
address/
alC - 11e-�C.1 (:I. CD
CC ection/ ot number) (grave number)
Q `
GName of Sexton or Person in Charge of Premi s � `,fl�1� ��%�� Q�
Z Cl (please prin�t)�
7
W Signature �iy+t t4.I e. -� Title `71 1 �� ` 11 'C 1�
DOH-1555(07/18)p 1 of 2
017419
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#
LOZOWSKY
NAME Peter Lozowsky ge: Q�`J
Lot Owner:peter Lozowsky
Lot# Seneca 6C Grave# 2
Case: Concrete
Died: 1 •02CI•o? Interred: 2 . 5.2 4
Funeral Home:Carleton'S FH
Cemetery: Pine View
w
LOZOSKY
Lot No.6-c
Address 14 Pine St . Hudson Falls NY 12839l Section No.
Owner Peter Lozo.sky Plot Seneca
Date 10/10/02 -
Approx. 100 Superficial ft.
Location Bounded. on North by Mackintosh & Vacant , South by Road,
East by Schenk, West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 3198
Payment Record Paid in Full 10/10/02 ($1 , 200.00)
Record of Interments
t 1 : 4v/-0 4 4c-4 ✓i
s 4 c
+ �f
A t�
N /�
is R. 0
Form No. 01