Lenhart, Doris Marie NEW YORKSTATE DEPARTMENTOF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Doris Marie Lenhart I Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/19/2019 73 Years War or Dates
II.— Place of Death Hospital,Institution or
WCity,Town or Village Plattsburgh Street Address Meadowbrook Healthcare
p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
Kevin McCullum MD
Address
96 Court St,Plattsburgh,New York 12901
Death Certificate Filed District Number Register Number
City,Town or Village Plattsburgh 0901 596
Burial Date Cemetery,Crematory or Facility Name ,
12/23/2019 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
❑Donation
Z Date Place Removed
0 R Removal and/or and/or Held
N
Hold Address
dDate Point of
to FITransportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
f. Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2019 Registrar of Vital Statistics Sy(via Cj warrotte(ECectronicalrySigrred
(signature)
District Number 0901 Place Plattsburgh, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
WDate of Disposition -Zp—/ Place of Disposition R t/ address/
W
N /section/ (lot number) (grave number/
0 Name of Sexton or Person in Cha a of Pre ses
Z /please print/
W Signature , Title O
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) Y 0 1 3-1 6 8
Receipt
Human remains of delivered on 1 ' , 20 L
Pine View Cemetery Representing the fuperaf home named on burial permit
Official Funeral Directors Rag.or License#
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