Martindale, Lillian — NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lillian Martindale Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 22,2013 89 War or Dates
f., Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address Westmount Health Facility
`p Manner of Death n Natural Cause Accident 0 Homicide n Suicide n Undetermined Pending
Circumstances - Investigation
C Medical Certifier Name Title
Roslyn Socolof
Address
Westmount Health Facility,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 (
0 Burial Date Cemetery or Crematory
El Entombment September 27,2013 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, ,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
yE Transportation Shipment
p by Common Destination
Carrier
Li Disinterment Date Cemetery Address
ni Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
C4
a. Permission is hereby granted to dispose of the human re ains described� above as indicated.
Date IssuedA i ac - �--t Registrar of Vital Statistics G. `l 0--L______
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iZ Date of Disposition q/6V1(2-0 1.3 Place of Disposition /rl, }),EL<J (addr s: /k d44Gr12.4•a ,�3/�)
CO
p0 (sec�ts!JJn) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises ( 04.4JIE L. t�0 �E_/�'
iu
Z (please print)
Signature 4. ,( Title ee-(, —sc"..a..._„(-.-
(over)
DOH-1555(02/2004)