Lamy, Leo NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leo R . Lamy Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 28 , 1997 88 WarorDates Yes WWII
Place of Death Hospital, Institution or
Odt�, Town cKVAI,*ge Al tamont Street Address Mercy Health Care Center
Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pend*ng
Circumstances Investigation
Medical Certifier Name Title
Dr . Josh Schwartzberg 00
Address
212 Lake Flower Ave . Saranac Lake , New York 12983
Death Certificate Filed District Number __j_Register Number
Gdby, Town oc VAInge A l t a m o n t 1 6 5 0
Date Cemetery or Crematory
El Burial April 30 , 1997 Pine View Cremator
Address
X❑Cremation Quaker Road , Queensbury , New York 12804
Date Place Removed
Z ❑Removal and/or Held
•• and/or Address
Hold
Q Date Point of
N ❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Fortune-Keough Funeral Home , Inc . 00678
Address
40 Church Street Saranac Lake , New York 12983
Name of Funeral Firm Making Disposition or to Whom
.. Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated
Date Issued 4-2 9-9 7 Registrar of Vital Statistics
(signature)
District Number 1 6 5 0 Place Town of A L t a m o n t
I certify that the remains of the decedent identified above were disposed of in accordanntce with this permit on:
W Date of Disposition.�s Place of Disposition 11611 IV c_"% /to/��l
(address)
Lq
(section) (lot num er) grave number)
GName of Sexton,?r Person in Charge of,IPremises 2
(please print)
Signature Title e__Irr_7��4
DOH-1555 (10/89) p. 1 of 2 VS-61