Edwards-Lamb, Tamara 4tj7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Tamara Edwards-Lamb Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/08/2020 60 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Providence Town Street Address 160 South Line Rd, Providence Town,New York 12850
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ❑Pending
Circumstances Investigation
U
W Medical Certifier Name Title
CI Agee!Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Middle Grove 4564 f
❑Burial Date Cemetery,Crematory or Facility Name
12/09/2020 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
0 Donation
ZO Removal Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
t/) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2020 Registrar of Vital Statistics Susan Wempk gkctronicall:y Signed)
(signature)
District Number 4564 Place Middle Grove, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition (Z Ito I to Place of Disposition
2 (ad ress/
W
CC CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Pre .ses
Z (pleas print)
W Signature Title OtiM11117(t.
DOH-1555(07/18)p 1 of 2
.
Public Health Law Sec. 4145(2b) `-�
•
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#