Lamb, Patricia f * a, t ..
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
n:: Name First Middle Last Sex ,
Patricia M. Lamb Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 11,2011 90 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Westmount Health Facility
Manner of Death IA)Natural Cause ri Accident piHomicide n Suicide in Un determined Pending
Circumstances Investigation
Medical Certifier Name Title
Address 4_
^Z , 6� 1 U
Death Certificate Filed _T District Numbe5657 Regis Number
City, Town or Village Queensbury / t r
El Burial Date Cemetery or Crematory
❑Entombment August 15,2011 Pine View Crematorium
Address
®Cremation 21 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z ri Removal and/or Held
2 and/or Address
H Hold
07
0 Date Point of
N L Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
#;„ Permit Issued to Registration Number
k:. :, Name of Funeral Home Regan & Denny Funeral Home 01443
Address
i 53 Quaker Road,Queensbury,NY 12804
': Name of Funeral Firm Making Disposition or to Whom
i:► Remains are Shipped, If Other than Above
NAddress
Ixf
:. Permission is hereby granted to dispose of the human rem ins de cribed above a :indicated.
ii
Date Issued �- /� ,i/ Registrar of Vital Statistics G(,C, e(7 A
/ (signature)
:: District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LUDate of Disposition g-.-IS_').0 t( Place of Disposition 'net,'L.per CC-e,ncyk$.tr,ui vn
Ili (address)
CO
It
Premises (tero — i i pot number) (grave number)
zName of Sexton or Person in Charge," 1 w d' �1.. I �Cv VI el
fL ��`~Y (please pant
Signature (: ,ti AIL Title Cr'•evvlcA Off t •
(over)
DOH-1555(02/2004)