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Lamphere, Jessie NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jessie Lamphere Female Date of Death Age If Veteran of U.S.Armed Forces, 05/22/2020 73 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare WManner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title c Edit Masaba MD Ow Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 17 ©Burial Date Cemetery,Crematory or Facility Name 05/27/2020 West Glens Falls Cemetery Entombment Address ❑Cremation West Glens Falls,New York ❑Donation Z Removal Date Place Removed P and/or and/or Held F N Hold Address O d• Date Point of fAElTransportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition orto Whom H Remains are Shipped,If Other than Above Address Q W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/26/2020 Registrar of Vital Statistics S&egyMckernnn��Yectronicaf Srgned) (sigature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 5/2 6/2 0 2 OPlace of Disposition 21 Quaker Rd. Queensbury NY 12804 lu (address) W WGF N (section) /!at number/ (grave number/ 8 Name of S744-41e, Person in Charge of mises Connie Goedert (Please print) W Signature Title Superintendent DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010 3 3 9 Receipt Human remains of delivered on , 20 e View CemeteryRepresenting the funeral home named on burial permit P g Official Funeral Directors Reg.or License# 1 LAMPHERE NAME JESSIE LAMPHERE Age: 73 Lot Owner: LAMPHERE FAMILY PLOT Lot# WGF Grave# Case: CONCRETE Died: 5/2 2/2 0 2 0 Interred: 5/27/2020 Funeral Home: singleton Sullivan, Potter Cemetery: Pine View Cemetery