Lintner, Virginia NEW*YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
__-
MI Name First Middle Last Sex
Virginia Lintner Female
Date of Death ' Age If Veteran of U.S. Armed Forces,
:4 09/07/2018 93 Years War or Dates
€';74 Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause —'i� Accident r -1 Homicide ! Suicide 1 Undetermined L i Pending II 1
Circumstances Investigation
Medical Certifier Name Title
Jean Vanauken PA
. Address
100 Park St,Glens Falls, New York 12801
tii, Death Certificate Filed District Number ! Register Number
City Town or Village Glens Falls 5601 1 423
ri Burial Date Cemetery or Crematory
09/10/2018 PineView Crematorium
--JEntombment Address
KCremation Queensbury Town, New York
frAl Date Place Removed
1 L Removal _ and/or Held
and/or Address
Hold
1 Date Point of
1-7 `i Transportation Shipment
Pby Common Destination
it Carrier
a Disinterment Date Cemetery Address
Date +Cemetery Address
- Reinterment
Permit Issued to 1 Registration Number
Name of Funeral Home Mason Funeral Home 1 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277 -I
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ht
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/07/2018 Registrar of Vital Statistics Wilbert Curtis ECectronicatt Sine
g < y Signed)
-e'J (signature)
DistrictPlace Number
5601 Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1,41
' Date of Disposition 1111) (It Place of Disposition ? V
a/ N tL- 0.rJ
(address)
, (section) (lot numb r (grave number)
l Name of Sexton or Person in Charge of Premises � . t•CA tr ' (please print)
ma
It
x
Signature Title m
(over)
DOH-1555 (02/2004)