Goodness, Lynda, Carney _ . _ # �jj
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lynda Carney Goodness Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/08/2019 72 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 59 Walker Lane,Queensbury Town,New York 12804
W
uup Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
C.)
W Medical Certifier Name Title
G Jill Gradner MD
Address
1783 Rte 9 Ste 102,Clifton Park Town,New York 12065
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 163
❑Burial Date Cemetery,Crematory or Facility Name
11/12/2019 Pine View Crematory
Entombment Address
c]Cremation Queensbury,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
d. Date Point of
N ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition orto Whom
F. Remains are Shipped,If Other than Above
Address
R
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/12/2019 Registrar of Vital Statistics CaroC:neWi-fdgard Bader(Ekctro=i allySyffed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition IZ Ili Place of Disposition f�Uu•
NJ (address)
2
W
0 (section) 1 (tot number) (grave number)
GName of Sexton or Person in Charge of Premises
Z (p ase print/
W Signature r,✓` (> Title
DOH-1555(07/18)p 1 of 2
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Public Health Law Sec. 4145(2b) 13
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Receipt
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Human remains of delivered on , 20
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Pine View Cehietery — Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#