Lynch, Judy w-
NEW YORK STATE DEPARTMENT OF HEALTH `"`" ' ;-Oti
Vital Records Section Burial - Transit Permit
iiil Name First
Middle Last Sex
Judy L. Lynch Female
ai Date of Death Age If Veteran of U.S. Armed Forces,
Mi War or Dates
Place of [ a h 07, 2018 71 yrs. Hospital, Institution or no
City, Town or VillageGlens Falls Street Address Glens Falls Hospital
Manner of Death BNatural Cause 0 Accident 0 Homicide 0 Suicide Undetermined El Pending
Circumstances Investigation
ill Medical Certifier Name Title
0 Sean Kimball MD,
ni Address
79 North St. , Granville, NY. 12832
iiiii Death Certificate Filed District Number Register Number
ag City, Town or Village Glens Falls 5601 V- 2 _1--1
Date Cemetery or Crematory
❑Burial March 0.7,_ 2018 PineView Crematorium
—
Address
::. CICremation Quaker__ 'r . , Queensbury, NY. 12804
Date Place Removed
0❑Removal and/or Held
-- and/or Address
F. Hold
Q Date Point of
yQ Transportation Shipment
5 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Fteai�s7
tration Number
Name of Funeral Home Mason Funeral Home
Address
18 George St. , Fort Ann, NY. 12827
': Name of Funeral Firm Making Disposition or to Whom
'" Remains are Shipped, If Other than Above
Address
I
44 0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3/0 7/2 01 8 Registrar of Vital Statistics -
t+ 'r " - n"--e
Mi
(signature)
District Number 5601 Place C, ty of ( 1 Pnc Pal 1 s, NY_
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3/Iirg Place of Disposition ..111.4, LOON,_
,' (address)
tl
U
CC (section) A (lot nupber) (grave number)
GName of Sexton or Person in Charge Premises ,,, ,,,,Alt
z ,4 (please print)
1'. Signature �,� +� Title [RAM,
•
(over)
DOH-1555 (9/98)