Ramsden, Lester NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Lester Ramsden Male
... ... ....... ......... ............... ... ..... .......
Date of Deatli Agee If Veteran of U.S.Armed Forces,
Dec 1 1 , 1992 82 War or. Dates N/a
H _ ... ....... ... . .................: .....:.:::... .. .. ............................... ......... ......... ......... .. ............. . ........ ......
Z Place of Death Hospital, Institution or
L City,Town or Village Cambridge Street Address Mary McClellan Hospital
_...
...........................
anner of Death ® Natural Cause Accident Homicide Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
. . .......:..:......... ...:..: :: ... .. - ...... .....::. .....::: ........ .......... . ::::::: ,:::::.::
Medical Certfier Name Title
0 David .A.... Jackson. MD
... ... ... ..... .......... ......... ................. .....:::....
......... .......
Address
So Union Street Camb.x�idge.,.:..iVY1 281 (.:::....; . _ ...........
.........:..:...::.
Death Certificate Filed District Number Register Number
City,Town or Village Cambridge
Date Cemetery or Crematory
❑Burial Dec. 14, 1992 Pine View Crematorium
.......... . : :. ......... . .. .::::::
®Cremation Address
Quaker Rd Queensburyr NY 12804
.::......................:..... ..........
Z Date Place Removed
O ❑ Removal and/or Held
1 and/or Hold ..: .......... ..... ...................:_. _. ............. ; ... ....... ,...... ...... .. ..:.. ....
Address
N
0.............. :......... .......................: ................ ......::_: .....................
a Date Point of
n ❑Transportation by': Shipment
p Common Carrier ....::.::..:
Destination
.... ...:_ .:: _ :.:.....: .......... .:::::.: .... .:..,._.::::.
❑ Disinterment Date Cemetery Address
.:::: ....:: .::: .......... ..............................................................
❑ Reinterment Date Cemetery Address
Permit Issued to Flynn Bros. Inc Registration Number
Name of Funeral Firm 00667
...... ........._ ... _............ ..
Address
80 Main Street Greenwich, NY 12834
.... :..... .....:: ..........::.:................................. ..... _ ........ . .... ....... . ........ ......... ......... ......
f". Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
_:.:..: :::.:... : .............,:..:......:......:.:.:...... . ..:.::. .. -........ .......... -....... . .............
u1
Address
a .
9 p
Permission is hereby ranted to dispose of the human remains described above as indicated.
Date Issued Dec 1 2, 19 9?Iegistrarof Vital Statistics o���A� :L d�
(signature)
i
District Number 37� Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W' Date of Disposition ��"� 02 Place of Disposition /�%/�.�
W (address)
w
W (section) (lot number) (grave number)
cc /
p Name of Sexton or erson in Charge of Premis s
z (please print)
w Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61