Lyng, Toni NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Toni Jean Lyng Female
Date of Death Age If Veteran of U.S. Armed Forces,
0 2/1 4/2 01 6 45 War or Dates
Place of Death Hospital, Institution or
City,-Tewn.or Village Fort Edward Street Address 13 State Street,
la
03 Manner of Death®Natural Cause 0 Accident Homicide Suicide ❑ Undetermined Pending
Ili Circumstances Investigation
at Medical Certifier Name Title
0 't AdNt dress�+d`cs s S w..f.,ti &N. ( 8O S� ) 4.
(,�J'Gno� 4 Q�h � Lev� ;eLA- � Z(� pipe ;�I �N��%Zi;v�
Death Certificate Filed District Number n ( Register Number
City, Town or Village I�`T /
Miil0Burial Date Cemetery or Crematory
02/17/2016 Pine View Crematory
❑Entombment Address
Ili[3Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
❑Removal and/or Held
and/or Address
t Hold
0 Date Point of
i Transportation Shipment
GE by Common Destination
Carrier
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral CAre 00364
' `' Address
iii 402 Maple Ave, Saratoga Springs, NY 12866
` Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
al Address
tli
a Permission is hereby granted to dispose of the human rem ' s described abov asind' ated.
iii:i //'7 Date Issued 2 /o2ot(p L: I�n Registrar of Vital Statistics �/ Y
(signature)
District Number 57a t Place -fuF_� � �
" lJ
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
til Date of Disposition Zf,'t(h, Place of Disposition erkiii,i, Ct+Mct7r�
E (address)
Ili
tr (section) (lot number (grave number)
Name of Sexton or Person in Ch rge of Premises Art) ,(�I_'"'•""
2 (pl ase print)
44 Signature Title LTtrt1
(over)
DOH-1555 (02/2004)