Lynn, Christine NEW YORK STATE DEPARTMENT OF HEALTH,- Zq,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Christine C. Lynn Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/09/2011 G 0 years War or Dates
Place of Death Hospital, Institution or
ifi City, Towjeiljp�XXX Glens Falls Street Address Glens Falls Hospital
Manner of Death❑IJatural Cause El Accident El Homicide Ej Suicide ri Undetermined �Pending
t Circumstances Investigation
W Medical Certifier Name Title
Noelle Stevens M D
Address
100 Broad Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
€< City, TowymoillaXXX Glens Falls 5601 265
i!iliiii ❑Burial Date Cemetery or Crematory
❑Entombment 06/10/2011 Pine View Crematorium
Address
DCpemation Queensbury, NY 12804
Date Place Removed
Z MRemoval and/or Held
P:4and/or Address
cn
0 Hold
Date Point of
er.i 0 Transportation Shipment
G by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01149
Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address •
i
Permission is hereby granted to dispose of the human remains described above as indicated.
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>> Date Issued 06/10/2011 Registrar of Vital Statistics
CA �(ignat� )
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z /''
I Date of Disposition 6--t3-ti Place of Disposition etOt�� `ran-ctOrau,,
(address)
Ili
tfl
C (section) (lot num (grave number)
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Name of Sexton or P rson in Char of Premises �riS ',Dive- r„M,t(-
Z �! ''� (please print)
Signature r,k.. Title 01-0 f)NTO(
(over)
DOH-1555 (02/2004)