Lambeth, Christopher NEW YORK STATE DEPARTMENT OF HEALTH .. # +'7J
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Christopher C. Lambeth Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 4,2015 46 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Warrensburg 1 Street Address 9 Victory Court
Manner of Death 1 Xi Natural Cause Accident I I Homicide Suicide Undetermined Pending
Cti
U Circumstances Investigation
ui Medical Certifier Name Title
0 John Stoutenberg
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number —
City, Town or Village
❑Burial Date Cemetery or Crematory
El
Entombment August 6,2015 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
O and/or Address
CO Hold
V
a Date I Point of
CO Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I
Reinterment Date ! Cemetery Address
I
Permit Issued to ' Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
'I Name of Funeral Firm Making Disposition or to Whom
1-1 Remains are Shipped, If Other than Above
al Address
tests'
Permission is hereb granted to dispose of the human r i described above as indicated.
Date Issued W" /S Registrar of Vital Statisti i .x`K-----
(signature)
District Number 57 6e Place /D 1 n /
I f{JltirEv,S 6pr lV /l en
I certify that the remains of the decedent identified above ere disposed of in accordance with this permit on:
wI—
Date of Disposition II Mc Place of DispositionfZU.„./ /7,-..fia....—W (address)
co .
ce
(section) I blot numberSsAvt (grave number)
p Name of Sexton or Person 'n Char of Premises '=.�dLh
Z ;-v (please print)
W r
Signature Title iN'
. (over)
DOH-1555 (02/2004)