Lamphear, Edward James NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edward James Lamphear Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/21/2021 71 Years War or Dates
Place of Death HospitaWnstitution or
Z City,Town or Village Glens Falls Street Ad ess Glens Falls Hospital
WManner of Death Undetermined Pending
❑X Natural Cause El Accident Homicid ❑Suicide ❑
U Circumstances Investigation
W Medical Certifier Name Title
Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 43
❑Burial Date Cemetery,Crematory or Facility Name
01/22/2021 Pine View Crematory
ElEntombment Address
0 Cremation Queensbury Town,New York
❑Donation
OZ Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I.— Remains are Shipped,If Other than Above
Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/22/2021 Registrar of Vital Statistics 16,6ertf7ndrew Curtis(E1ectronicallySgned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
E—
Z Date of Disposition /—,43—.2t?ZI Place of Disposition Je- Cremdvf�(
2 laddrosr
W
CC
N (section) J (lot num`berr)) (grave number)
0 Name of Sexton or Person in Charge of Premises ' �y�'�'�`" E. �'"�'
Z (please print)
tL Signature /I- /2/ Title Q�efecio
O "
DO H-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
451
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#