Lindsey, Lois Irene . . ,
14360
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lois Irene Lindsey Female
Date of Death Age If Veteran of U.S.Arm, 1 Forces,
05/25/2022 86 Years War or Dates
F Place of Death Hospital,Institution or
W City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
O Manner of Death ['Natural Cause ❑Accident 0 Homicide Suicide FlUndetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
0 Came Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 44
EiBurial Date Cemetery,Crematory or Facility Name
05/27/2022 Pine View Crematorium
Entombment Address
['Cremation Queensbury Town,New York
Donation
Q Removal Date Place Removed
and/or and/or Held
F Hold Address
N
0
Date Point of
N❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
DisintermentID
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/27/2022 Registrar of Vital Statistics Aimee G 9Kafwney(E(ectronicalfy Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Date of Disposition $-Z 2z Place of Disposition 10 e_ i er.J e/e1N t�)'�
2 (address)
W
CC (section) (tot nu er)a (grave number)
zzName of Sexton or Person in Charge f Premises e��mUa� `
=,f (pie s print)
W Signature �!/ Title ed�O�`
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 buri*lycrmit
Official Funeral Directors Reg.or License#