Lanning, David NEW YORK STATE DEPARTMENT OF HEALTH 331
Vital Records Section Burial - "transit Permit
r, Name First ddle Last Sex
;= David Joseph Lanning Male
t Date of Death Age If Veteran of U.S. Armed Forces,
05/03/2015 71 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Elizabethtown Street Address Deceased's Residence
Manner of Death Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending
Lit
�: Circumstances Investigation
Medical Certifier Namp, Title
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Death Certi irate Filed // District Number /5 S i Register Number
City, Town or Village
E
Date Cer�e or Crje�}ato ^
trombment 05/07/2015 l// �-, </ C ge LL/®C/!/M-1
Address ��" ��cdL�� ���� /2--IfFe
®Cremation
Date Place Removed
•z• Removal and/or Held
and/or Address
Hold
Date
Point of
IITransportation Shipment
by Common Destination
Carrier
., i' Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
,` 9 Pine St/P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is h e granted to dispose of the human r ins e cribed above a ' dicated.
Date Issued / Registrar of Vital Statistics- �-�
.. — (signature)
District Number /5 S—d_ Place
41t4-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 5�71►S Place of Disposition 41 fir'
(address)
(section) ' (lot numbe (grave number)
Name of Sexton or Person in Charge of Premises "V
(please print)
11 Signature ._, Title liter•091.
(over)
DOH-1555(02/2004)