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Lamphere, Louise — 0 # 1 sit NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ‘• Name First Middle Last Sex • Louise J Lamphere Female Date of Death Age If Veteran of U.S. Armed Forces, - 06/07/2018 95 Years War or Dates 2 Place of Death Hospital, Institution or City, Town or Village Granville Town Street Address The Orchard Nursing And Rehabilitation Centre • Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined 17❑Pending Circumstances Investigation it' Medical Certifier Name Title Jennifer Hayes MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City, Town or Village Granville 5756 20 ❑Burial Date Cemetery or Crematory 06/08/2018 Pine View Crematory Li Entombment Address ®Cremation Queensbury Town, New York A Date Place Removed ❑Removal and/or Held and/or Address - Hold Date Point of ❑Transportation Shipment • by Common Destination • Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address • Permit Issued to Registration Number - Name of Funeral Home Jillson Funeral Home Inc 00885 Address Ny 46 Williams Street,Whitehall Village,New York 12887 �g Name of Funeral Firm Making Disposition or to Whom - Remains are Shipped, If Other than Above Address t Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/07/2018 Registrar of Vital Statistics jenny Linda 911arteCfe(ECectronica1Cy Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iZ p I Date of Disposition 6!11 III- Place of Disposition 1..,U,,., (address) (section) (lot,lumber) (grave number) o - Name of Sexton or Person in Charge of P emises 4 (please rint) S +r to Signature l Title ( ir- (over) DOH-1555 (02/2004)