Lindstrand, Emil August �_ y
NEWYORK STATE DEPARTMENT OF HEALTH ` /Buriai
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Bureau of Vital Records nsit Permit
Name First Middle Last Sex
Emil August Lindstrand Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/09/2020 92 Years War or Dates 1945-1947
Place of Death Hospital,Institution or
Z City,Town or Village Granville Town Street Address Haynes House of Hope
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p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
V Circumstances Investigation
0 Medical Certifier Name Title
Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Granville 5756 7
Burial Date Cemetery,Crematory or Facility Name
02/11/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
F-
N Hold Address
O
(L Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/11/2020 Registrar of Vital Statistics 7ennyzmdaMart--&(Ek--tronicallySywg)
(signature)
District Number 5756 Place Granville, 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 Z I IZ 170 Place of Disposition fl—
W
� (address)
W
N
� (section) / l/at number/ (grave number/
Name of Sexton or Person in Cha of Premises
Z /p ase print
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 13 3
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#