Lance, Vonda NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Vonda Lee Lance Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/04/2018 74 Years War or Dates
EL Place of Death Hospital, Institution or
tt City, Town or Village Glens Fairs Street Address Glens Falls Hospital
W Manner of Death Natural Cause El Accident El Homicide El Suicide Undetermined Pending
Circumstances Investigation
• Medical Certifier Name Title
Kasandra Frasier PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
; City, Town or Village Glens Falls 5601 571
El Burial Date Cemetery or Crematory
12/05/2018 Pine View Crematorium
;. ❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
ri Removal and/or Held
and/or Address
Hold
in
O Date Point of
Po El Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
;, Ei Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
IRemains are Shipped, If Other than Above
Address
Na
ali
�` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/05/2018 Registrar of Vital Statistics Rodert.,I Curtis tElectronicalrySigned)
(signature)
District Number 5601 Place Glens Falls, Network
H' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LU Date of Disposition IZIl/ig Place of Disposition �,�I , ( -f----
2 (address)
2 (section) (Iht number) (grave number)
la Name of Sexton or Person in Charge of Premises /,hr"i �gA44V
1111l (pleas rnt)
Signature C Title MEN)ik
(over)
DOH-1555 (02/2004)