Sterling, Lexus NEW YORK STATE DEPARTMENT OF HEALTH 1 t-" t-I J
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lexus Lynn Sterling Female
R; Date of Death Age If Veteran of U.S. Armed Forces,
April 1, 2013 13 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death❑ Natural Cause 0 Accident El Homicide 0 SuicideLil—IUndetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Timothy Murphy, _:egeNeii?
Address
52 Haviland Ave Glens Falls, NY 12801
Death Certificate Filed District Number ,LQ Register Number r ,
Ci Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
Aril 5, 2013 Pine View Cremato
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
, Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is her by g anted to dispose of the human re ains de cribed ab e as indicat d.
int
Date Issued Registrar of Vital Statistics ���� ,
_ (signature)
: ���� !,�� /�j�
District Number / Place ��'I// c�-F,,
r j
I certify that the remains of the decedent identified above were disposed of in accordance ith this permit on:
Date of Disposition 04/05/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number (grave number)
/
Name of Sexton or Per on in Charge o Premises /4t,s 00 '
lease print)
J
Signature Title rt`t i4 NZ
(over)
DOH-1555 (02/2004)