Lamay, Donald NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Perm t
Vital Records Section
Name First Middle Last Sex
Donald J Lamay Male
Date of Death Age If Veteran of U.S.Armed Forces,
I„ July 28, 2011 Lei
or Dates
2 Place of Death Hospital, Institution or
W City,Town,or Village Granville Street Address The Orchard Nursing Centre, Inc.
0 Manner of Death 0 Natural Cause 0 Accident 0 Homicide nSuicide 0 Undetermined 0 Pending
W Circumstances Investigation
ti 0 Medical Certifier Name Title
W Dr. Jennifer Hayes, M.D. Dr.
0 Address
17 Madison Street, Granville, NY 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville grirb .`t 3
Date Cemetery or Crematory
ID Burial
August 1, 2011 Pineview Crematorium
l ❑Entombment Address
Cremation,'- Quaker Road Queensbury, NY 12804
Date Place Removed
0 0 Removal and/or Held
- and/or ;Address
Hold
0 Date Point of
0 0 Transportation Shipment
Q by Common Destination
i Carrier
Date Cemetery Address
5 Disinterment
Date,<;,. Cemetery Address
[]Reinterment
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00897
Address
46 Williams Street, Whitehall, New York 12887
1—
Name of Funeral Firm Making Disposition or to Whom
;�{, 'Remains are Shipped, If Other than Above
W �ti•
ress
^. f
Permission is„hereby granted to dispose of the human remains described above as indicated.
Date Issued 1/4.p/i Registrar of Vital Statistics
e/tefrch)lia,, ,ege,
(signatDistrict Number Place Granville,New York
F- I certify that the remains of the '. t identified abe disposed of in accordance with this permit on:
2 4,. rY � ,
W Date of Disposition 08/01/201 %Pl4e of*-
' ition Pineview Crematorium
W _; (address)
i! {` lion) (dot number) (grave number)
ZName of Sexton or Person in Charge of remises tkrp�J S b rt�
W (please print)
Signature4 �. Titki (. . al�"C'1Jit�
1.,F (over) -
DOH-1555 (02/2004)
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