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Randall, Lorraine F. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lorraine F. Randall _j __ Female Date of Death Age If Veteran of U.S.Armed Forces, 04/22/2020 96 Years War or Dates � Mace-f Death I Hospital,Institution or ZI City,Tovvn or Village Saratoga Springs Street Address Wesley Health Care Center Inc W-- 13 Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending UJEl __ Circumstances Investigation W Medical Certifier :Name Title Rick Teetz MD Address I 131 Lawrence St,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number j :iry own or`tillage Saratoga Springs 4501 248 Burial Date Cemetery,Crematory or Facility Name � Ertc rbmer,t 04/24/2020 Pine View Crematory� Address ICremation I Queensbury Town, New York Dor,aticn ; �'- Removal a12 Place Removed and/or and/or Held NHc!d ..--c-ess O IL — Date Point of (1) , Transportation �a by Common Shipment Carrier Destination -- Date Cemetery Address Disinterment i ---- -- Date Cemetery Address Reinierment Perm.,I..<.sued to Registration Number i �` Brewer Funeral Home Inc 00211 i Name: � FuneralH�me 4cdrF�s 2,. 0' ,h Street PC Box 500, Lake Luzerne, New York 12846 I NE r. of -uneral Firm Making Disposition or to Whom li-- eni< n�are Snipped,if Otherthan Above I- 4ddress is i-Lereby granted to dispose of the human remains described above as indicated. i nPte ­pd 04/24/2020 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) strii i Number 4501 Place Saratoga Springs, New York nu,the remains of t,ie decedent identifies,above were disposed of in accordance with this permit on: Z -_. `isr)osition 14" 3--ZOLD Place of Disposition ),19 V eicj �/ r►'1cc" /.l LA k6fS (address / 'section) (lot nu,iber) (grave nmr5er) LL 1 / C ��'Lme D.F Sexton or Ferrol arge f Premises yG- ` � � ��`�✓h y�' (please print) / i Sign _a e Title i L_. Public Health Law Sec. 4145(2b) 1) 3 0619 Receipt Human remains of delivered on , 20 Pine View Cemetery Repfesentidg the funeral home named on burial permit Official Funeral Directors Reg.or License#