Purrington, Lois NEW YORK STATE DEPARTMENT OF HEALTH. s_ S
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lois A Purrington Female
Date of Death Age If Veteran of U.S.Armed Forces,
October 21, 2012 72 War or Dates
2 Place of Death ' Hospital, Institution or
W City,Town,or Village Whitehall Street Address Residence
0 Manner of Death ®Natural Cause 0 Accident Ei Homicide 0Suicide 0 Undetermined 0 Pending
IIJ Circumstances Investigation
0 Medical Certifier Name Title
W Max Crossman MD
d Address
55 Beckett Road Whitehall New York 12887
Death Certificate Filed District Number 5-7ol O Register Number p�
City,Town or Village Whitehall Q
❑Burial Date Cemetery or Crematory
October 24, 2012 Pineview Crematorium
❑Entombment Address
is Z Q Cremation Town of Queensbury Queensbury, NY 12804
Date Place Removed
0 El Removal and/or Held
- and/or Address
F Hold
0 Date Point of
CD Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
a- El Disinterment
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
112 Remains are Shipped, If Other than Above
a Address
a.
Permission is hereby granted to dispose of the human r ains described above as indicated.
Date Issued /0/2,3//ol Registrar of Vital Statistics ice
(signature)
District Number 6'1013 Place Whitehall,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
w Date of Disposition 10/24/2012 Place of Disposition Pineview Crematorium
2 (address)
th
0 (section) At (lot number) (grave number)
Q Name of Sexton or Person in Charge o remises r, ,, 1-44g
W (p ase print)
Signature ç1L, Title Clr ii IM/did L.
(over)
DOH-1555 (02/2004)