Lockwood, Howard NEW YORK STATE DEPARTMENT OF HEALTH 4 IL 4t 3L
Vital Records Section Burial - Transit P rmit
Name First Middle Last Sex
Howard Lockwood Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 29,2013 92 War or Dates US Army
Place of Death Hospital, Institution or
City, Town or Village Street Address
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide n Suicide n Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Dr.Mihindu.MD
Address
" Glens Falls,NY I4 P
Death Certificate Filed District Number Register Number
City, Town or Village 5(,5f 49
❑Burial Date Cemetery or Crematory
El Entombment July 2, 2013 Pine View Crematory
Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
H Hold
N
d Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
j Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued '7-, /.3 Registrar of Vital Statistics i>e--; t j ayd
(signature)
District Number Place 4 ,.., «;,.-._.
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Lii Date of Disposition 7131 i) Place of Disposition .Roddiu.A.,, / ')fav
Ill (address)
N
re (section) Al,-
(lot num (grave number)
p Name of Sexton or Person in Charge of Premises
y
Z (please print)
W SignatureJ. Title (1 A)1ji L
(over)
DOH-1555(02/2004)