Garrison, Kathleen 6 11 # lq,
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section 4 Burial - Transit Permit
., Name First Middl Last Sex
l" Kathleen Jean Lamson Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 31,2018 85 War or Dates n/a
Place of Death Hospital, Institution or
y, City, Town or Village Schroon,NY Street Address 1328 US Route 9
7 Manner of Death ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide n Undetermined ❑Pending
Circumstances Investigation
I., Medical Certifier Name Title
` Christopher Hoy,MD
‘> Address
Queensbury,NY
Death Certificate Filed District Number Register Number
rh City, Town or Village Schroon,NY
❑Burial Date Cemetery or Crematory
❑Entombment February 2,2018 Pine View Crematory
Address
IXI Cremation Queensbury,NY
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
0 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 Regan Denny Stafford Funeral Home 01443
Address
_ 53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
r I
, Address
fl
., Permission is hereby granted to dispose of the human ains described bove as indicated.
Date Issued 'pg—q- /& Registrar of Vital Statistics ' �` .: �Ld Z44- :49
i (signature)
District Number /563 Place4,di /L'?irb� / 27 ` ,
I certify that the remains of the decedent identified above were disposed of in ccordance with this permit on:
w' Date of Disposition 2h, lit Place of Disposition Z.,V...- �,.,-e•iv r,�.
W (address)
co
iY (section) (lot number) (grave number)
pName of Sexton or Person in Charge of P mises ,.„� l.w- SsAAif
'Z (plea a print)
LI
Signature _ Lam( Title G&;iEtiagRl,
(over)
DOH-1555(02/2004)