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Goodall, Lloyd William
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lloyd William Goodall Male Date of Death Age If Veteran of U.S.Armed Forces, 01/14/2020 65 Years War or Dates II— Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title 93 Matthew Loftus PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 31 ❑Burial Date Cemetery,Crematory or Facility Name 01/16/2020 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held H N Hold Address O a Date Point of N ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Otherthan Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/15/2020 Registrar of Vital Statistics (RpbertAndrew Curtis(ECectronicalry Signed (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Place of Disposition 7 A)e ,L,, ,k-/V W (add ) W W (section) (umber) (grave number) lZ g Name of Sexton or Person i/C�hge of Pre ises ` �UZ (please print) W Signature Title OCLIYX DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 13 25 5 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# '