Lancour, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH 1 14N I/0
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth J. "Bette" Lancour Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 2, 2016 71 War or Dates
• Place of Death Hospital, Institution or
City, Town or Village Street Address The Pines
• Manner of Death J Natural Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined El❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Melissa Decker, Dr.
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Numbe��� Register�lyr�l�er
City, Town or Village J / 0� ,S
• ❑Burial Date Cemetery or Crematory
February 5, 2016 Pine View Crematory
• ❑Entombment Address
:$®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
., ❑ Removal and/or Held
and/or Address
Hold
Date Point of
• ❑Transportation Shipment
Of by Common Destination
Carrier
µ ❑ Disinterment Date Cemetery Address
❑ Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
iiii Address
123 Main St., Argyle NY 12809
= 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.
Date Issued 2. ) /2 i Registrar of Vital Statistics L 3 c p . n, L�� -
(signature)
District Number 5 1,01 Place 6�o�S ccx \\S ti y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
- Date of Disposition 02/05/2016 Place of Disposition Quaker Road Queensbury,NY 12804 Vine-V;tw Greivi{cr)'
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises -Tc'^rie..,>" 3E(.,;Co—S
(please print)
Signature, " Title rt,"``i{°e
(over)
DOH-1555 (02/2004)