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Vaughn, Lester A .— i-ffr tlip 41 NEWYORKSTATEDEPARTMENTOFHEALTH Bureau of Vital Records Burial Transit Permit Name First Middle Last Sex Lester A Vaughn Male Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2024 72 Years War or Dates 1,.. Place of Death Hospital,Institution or Z City,Town or Village Plattsburgh Street Address Champlain Valley Physicians Hospital Medical Ctr IJJ p Manner of Death Z Natural Cause Accident Ei Homicide Suicide nUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Peter Rattner DO Address 75 Beekman St,Plattsburgh,New York 12901 Death Certificate Filed City Of Plattsburgh District Number Register Number City,Town or Village 0901 75 Burial Date Cemetery,Crematory or Facility Name 02/08/2024 Pineview Crematory Entombment_ Address ©Cremation Queensbury Hamlet,New York Donation OZ Removal Date Place Removed and/or and/or Held p(7) Hold Address 0 d Date Point of Cl)❑Transportation El Common Shipment Carrier Destination 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 F Remains are Shipped,If Other than Above a Address C W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2024 Registrar of Vital Statistics Sylvia Gail Parrotte(Electronically Signed) (signature) District Number 0901 Place City Of Plattsburgh I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— /. Z Date of Disposition ,a&y Place of Disposition .--}rJC� i/' c'•.) C r am4t-o+ - (address W N CC (section) , (lot r) (grave number) GName of Sexton or Person in Charge of mises > �)' ��J, Z ' (p ease print) IL Signature v �f Title (2 ./7,4,40i` DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) , Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#