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Lyman, David • NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last ' Sex David James Lyman Male Date of Death Age If Veteran of U.S.Armed Forces, 03/18/2018 74 Years War or Dates Place of Death Hospital, Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital , Manner of Death Undetermined Pending©Natural Cause �Accident �Homicide �Suicide Circumstances Investigation Medical Certifier Name Title Dean Reali DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 142 ❑Burial Date Cemetery or Crematory 03/21/2018 Pine View Crematory ❑Entombment Address Cremation Queensbury Town, New York Date Place Removed El Removal and/or Held and/or Address Hold Date Point of 3 y 6r Q Transportation Shipment by Common Destination Carrier El Disinterment Date Cemetery Address t a Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address r , 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. F.:y..i x66• Date Issued 03/20/2018 Registrar of Vital Statistics VenA Curtis 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 3)1.311g Place of Disposition Q� t.4..'f-- (address) • (section) j (lot number) (grave number) /h" \ Name of Sexton or Person in Charge of Premises 1 (p ase print) Signature ij Title r►ti TAIL (over) DOH-1555 (02/2004)