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Lampmon, Donald Francis I0dg NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Francis Lampmon Male Date of Death Age If Veteran of U.S.Armed Forces, 09/27/2020 74 Years War or Dates Vietnam Place of Death Hospital,Institution or W City,Town or Village Argyle Town Street Address 2308 Lick Springs Road,Argyle Town, New York 12809 1p Manner of Death © Natural Cause ❑Accident 11 Homicide Suicide Undetermined D Pending Circumstances Investigation W Medical Certifier Name Title O Kristen Kelley DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 35 ❑Burial Date Cemetery,Crematory or Facility Name 09/29/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation ORemoval Date Place Removed and/or and/or Held Hold Address 0 O. U) Li Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above M Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/29/2020 Registrar of Vital Statistics Shelley Mckernon(ECectronicatrySigned) (signature) 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 9/30 r TO Place of Disposition 2 (address) W CC (section) A (lot number) (grave number) • Name of Sexton or Person in Charge of Pr es �'° L 0.4IIft Z (plee se print) /' W Signature Title L �'�"�{ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0140a0 Receipt Human remains of f``' " delivered on' , 20 I Pine View Cemetery Representing the funeral home named on burial,permit 1 Official Funeral Directors Reg.or License#