Lunt, Virginia May NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Virginia May Lunt Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/01/2020 82 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
QMedical Certifier Name Title
David Foote MD
Address
340A Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 98
Burial Date Cemetery,Crematory or Facility Name
03/02/2020 PineView Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0 ❑Removal Date Place Removed
and/or and/or Held
F N Hold Address
IL Date Point of
to ❑Transportation
0 by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
�.. Remains are Shipped,If Other than Above
Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/02/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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:
F—
Z Date of Disposition 3 13 1 ZO Place of Disposition
W ✓ (i
�i (address/
W
N
M (sea/an) ((at number) (grave number)
aName of Sexton or Person in Charge of Premises �t NNE
Z (ple a print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013360
Receipt
Human remains of ,' '' ! ;' 'y "delivered on 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#