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Pittman, Lorraine c3j NEW YORK STATE DEPARTMENT OF HEALTH' _s( Vital Records Section Burial - Transit Permit ...: Name First Middle Last Sex ice. Lorraine M. Pittman Female : f Date of Death Age If Veteran of U.S. Armed Forces, , ° March 25, 2015 66 War or Dates '°:' Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address 21 Franklin Street Manner of Death I xl Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title ilit Dr Gillani,MD Address r Glens Falls,NY Death Certificate Filed District Number Register Number : : City, Town or Village Glens Falls,NY 5601 J(93 ❑Burial Date Cemetery or Crematory March 26, 2015 Pine View Crematorium ❑Entombment Address ❑x Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z I l Removal and/or Held and/or Address H Hold N 0 Date Point of NTransportation Shipment Q by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address . ) ▪ Permit Issued to Registration Number ::;;e: Name of Funeral Home Regan Denny Stafford Funeral Home 01443 r Address , 53 Quaker Road,Queensbury,NY 12804 :::„:: Name of Funeral Firm Making Disposition or to Whom t^ Remains are Shipped, If Other than Above Address lg • Permission is hereby granted to dispose of the human r ains d cribed above as ind' ated x:: :�;E° Date Issued 03 J &/s/Registrar of Vital Statistics 'L4..77 l -P I (si nature) f District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above wer di posed of in accordance with this permit on: Z l�/ W Date of Disposition 3'; ?i I Place of Disposition /Alt- c9,1.7A4H dress / `y. Ws U) Ce (section) Q (lot,umb r)t (grave number) ap Name of Sexton r in Charge of Premises 0'\C`� ` Z (Please print) W Title s( / ` Signature -''--`-- (over) DOH-1555(02/2004) PITTMAN Lot No. Address Section No. 21 Franklin Rt , Glens Fa11a, NY 1 7R(11 Owner Lorrai nP A Fran_kl in Pitt Plot Algonquin _5'f 6 gl OZ-_ Date 3/30/2015 CP kpprox 16 Sq. Ft. Superficial ft. Location Bounded on North by Merril-Dew, South by Vaoant Fact by Krulik and WCSL by Vacant Corner Posts Remarks Deed No. (and changes) 3-091 Payment Record Paid in full, $4 0 0, 3/3-A/2 91 5 Record of Interments as, ao iS Lorraine Pittman 4/11 /20ts. .- z mecr,liheuo s a © 1 n 4 s wZ >9— �► I V tiI Form No. 01 NAME Pittman, Lorraine (1;It) Age: 66 Cause: Natural Lot Owner: Lorraine & Franklin Pittman Lot # 93C, Algonquin Crave # Cremation Case # Died: 3/25/2015 Interred: 4/11 /201 5 Undertaker: Regan Denny Stafford