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Lillibridge, Eric C r r Z NEW YORK STATE DEPARTMENT OF HEALTH ., Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Eric C Lillibridge Male Date of Death Age If Veteran of U.S.Armed Forces, 11/01/2021 66 Years War or Dates ZZ Place of Death Hospital,Institution or City,Town or Village Corinth Town Street Address 62 Hack Road,Corinth Town,New York 12822 LU 0 Manner of Death ©Natural Cause El Accident El Homicide El Suicide ❑Undetermined ❑Pending W V Circumstances Investigation LU G Medical Certifier Name Title David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 22 ElBurial Date Cemetery,Crematory or Facility Name 11/05/2021 Pineview Cremaotry El Entombment Address lCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held t- Hold Address N 0 a Date Point of Cl) ❑Transportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address ce W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/04/2021 Registrar of Vital Statistics Brenda L Penis(Electronically Signed) (signature) District Number 4553 Place Corinth, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition Ills11i1 Place of Disposition ?naL, (;16......._ W 2 (address) W U) CIC (section) (Lot number) (grave number) gName of Sexton or Person in Charge of Premises �t�l I`. 4�r ZZe, (pl a print) !U Signature c— Title � ����..�� DOH-1555(07/18)p t of 2 )152998 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#