Lambert, Adella NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ADELLA LAMBERT FEMALE
Date of Death Age If Veteran of U.S. Armed Forces,
1 1/18/199tw 8c War or Dates
Place of Death Hospital, Institution or
City, Town or Village t.REENF I ELD Street Address 390 ORIrISBEE RUAD
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
DAV I D H. S�I I NGARN M. D.
Address
ONE VEJ'ERANS WAY, SARA T OUA SPRINGS, N. Y.
Death Certificate Filed District Number Register Number
City, Town or Village GREENF I ELD 4`i5 7 12
Date Cemetery or Crematory
Burial 11/18/1996 PINEVIEW CREMA'i-ORIUM
Address
Cremation OUEENSDURY, N. Y.
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home DENSMORE FUNERAL HOLE, INC. 0052
Address
7 SHERCYIAN AVENUE, CORIN-fH, N. Y. 1L8E2
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 humatra)is de
zcribed apovevap indicated.
[ Date Issuedl 1/18/1 qy6 Registrar of Vital Statistics
UCJ�
(signature)
District Number4 7 Place CREENF IELD
I certify that the remains of the decedent identified above were disposed of,inraccordance with this permit on:
gW. Date of Disposition Place of Disposition�/�<<J�����'Gc� z 1
(address)
Uj
M (section) (lot umber (grave number)
0 Name of Sexton or Person in Charge of Premises ,�'��Ji91-P � f�j
lease print) -�--'
Signature Title ��
DOH-1555 (10/89) p. 1 of 2 VS-61