Lashway, Richard From: - 11/20/2015 15:59 #214 P_001/001
Maryland eu►ial Transit Permit �Z3
This permit must accompany remains to destination
File Number
1.Decedent's Name,AKA Name(Many) 2.Date of Death 3.Time of Death
RICHARD JOHN LASHWAY 11/14/2015 1006
4a.Facility Name 4b.City,Town or Location of Death 4c.County of Death
SCENE,1338 TRAILEE CIRCLE ABERDEEN HARFORD
5.Social Security Number 6.Sex 7.Age 8.Date of Birth 9.Birthplace
122284648 M 78 YR 08/19/1937 NEW YORK
10b.County 10c.City,Town or Location 10d.Inside City Limits?
10a.StateNEW YORK WARREN QUEENSBURY NO
10e.Addrosa25 EVANNA DRIVE lof.Zip Code 12804
11. Marital Status 12.Ever in U.S. 13.Hispanic Origin?NO 14.Race
DIVORCED(AND NOT Armed Forces? WHITE
REMARRIED) YES
15.Decedent's Education 16a.Decedent's Usual Occupation 16b.Business/Industry
HS OR GED PIPEFITTER COMMERICIAL PLUMBING
IT. Father's Name 18.Mother's Name Prior to First Marriage
KENNETH J.LASHWAY GENEVIEVE GEREAU
19.Surviving Spouse's Name
20e.informant's Name 20b.Informant's 20c.Informant's Mailing Address
LISA WILL Relationship 1338 TRALEE CIRCLE,ABERDEEN,MD 21001
DAUGHTER
21a.Method of Disposition 21b.Place of Disposition 21c.Date of Disposition 21d.Location
CREMATION PINE VIEW CREMATORIUM 11/19/2015 -,QUEENSBURY,NY
22a.Signature of Funeral Service Licensee 22b.License No 22c.Name and Address of Funeral Facility
HOWARD K MCCOMAS,IV s',°7;'; M00948 MCCOMAS FUNERAL HOME,P.A.
-1317 COKESBURY ROAD-,ABINGDON,MD 21009
Authority for Burial,Transportation,Removal,Cremation or Other Disposition
This burial permit,when completely filled in and bearing below the signature of the attending physician and funeral director,constitutes authority for burial,
transportation,removal,cremation or other disposition of the deceased named above.
Cemetery or Crematory Authority Shall Fill Out Section Below
The deceased named above was
.-, buried
cremated
in the cemetery or crematory named in item 21b.
Burial was in Section Lot Grave
Signature(Sexton or other person in charge) Date Signed
This burial transit permit must be signed above by the cemetery or crematory authority. Where there is no fill-time person in charge of the cemetery,the
funeral director may sign as the sexton.
If burial took place in Maryland,this permit must be returned within ten days to the:
Maryland Department of Health and Mental Hygiene
Division of Vital Records
6550 Reisterstown Road
Baltimore,Maryland 21215
29a.Certifier Type 29b.Signature and Tide of Certifier E1+1z, 29c.License No 29d.Date signed
MEDICAL EXAMINER PAMELA E.SOUTHALL,M.D. ®.< O.C.M.E. 11/15/2015
30e.Name of person who completed cause of death 30b.Address of person who completed cause of death
PAMELA E.SOUTHALL 900 W.BALTIMORE STREET,BALTIMORE,MD 21223
For Office Use Only:
31.Date Fled 32.Registrar at Filing 33.Date Issued 34.This is to certify that this is a true and correct copy of the official record on file in
the office of the Maryland Division of Vital Records.
Registrar's Signature