Murray, Lois / 7s---
. . ,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
i' Name First Middle Last Sex
iliii Lois A. Murray ?emale
Date of Death Age If Veteran of U.S. Armed Forces,
im
March 14, 2014 81 yrs. War or Dates no
iD
Place of Death Hospital, Institution or
City, Town or Village Granville Street Address Orchard Nursing Centre
Manner of Death®Natural Cause ❑Accident El Homicide ❑Suicide Undetermined ri Pending
Circumstances Investigation
1 Medical Certifier Name Title
P CI9R L 6ECk JER Y210
Addre
ATE,/ � air G� L�=Tr l/T; ,5�7�
Death Certificate Filed District Number 5r75.� Register Number
City, Town or Village Granville 1 (.0
Date Cemetery or Crematory
❑Burial March 17, 2014 PineView Crematorium
Address
:::: EICremation Queensbury, NY.
Date Place Removed
0 1-1 Removal and/or Held
�- and/or Address
Hold
0 Date Point of
si ❑Transportation Shipment
5 by Common Destination
Carrier
•
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
iie Permit Issued to Registration Number
»' Name of Funeral Home Mason Funeral Home 01 1 1 7
Address
<s>s 18 George St. , Fort Ann, NY. 12827
<'< Name of Funeral Firm Making Disposition or to Whom
"" Remains are Shipped, If Other than Above
IPAddress
ktil
a.
II Permission is hereby granted to dispose of the human remains described above as indicated.
5i!ii Date Issued 03/1 7/1 4 Registrar of Vital Statistics
ignature)
2151—
jj District Number552P Place Town of Granvi le, NY.
in
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
W Date of Disposition3 n—(V Place of Disposition PjrJ�V/ifv,J eee1m
(address) 1
LLI
N
CC (section) S.' nu ber) (grave number)
Name of Sexton o ers n C rge of Premises 6 F � �
z (please print)
t. Signature Title eitefold17Z- ifiS4 -
Z.
(over)
DOH-1555 (9/98)