Steves, Lynn A 0 C°,
NEW YORK STATE DEPARTMENT OF HEALTH @ LF
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lynn A.Steves Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/26/2022 72 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Whitehall Village Street Address 8 Elizabeth Street,Whitehall Village, New York 12887
WManner of Death El Natural Cause EAccident Homicide CSuicide Undetermined ❑Pending
V Circumstances Investigation
0 Medical Certifier Name Title
Donald Merrihew MD
Address
319 Bay Road,Queensbury Town,New York 12804
Death Certificate Filed Village Of Whitehall District Number Register Number
City,Town or Village 5728 11
Burial Date Cemetery,Crematory or Facility Name
niim 06/27/2022 Pineview Crematorium
Entombment Address
"Cremation Queensbury Town,New York
❑Donation
4 LRemoval Date Place Removed
and/or and/or Held
▪ Hold Address
0
0. Date Point of
#/#❑Transportation
by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
t Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
1.... Remains are Shipped,If Other than Above
N Address
CC
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O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/27/2022 Registrar of Vital Statistics Patti Gordon(Electronically Signed)
(signature)
District Number 5728 Place Village Of Whitehall
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �js�
w: Date of Disposition 612i 122 Place of Disposition ' I�� a--._
2 (address)
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Q (section) ,flat number) (1 (grave number)
8 Name of Sexton or Person in Charge of Pre ' � d\`,'^
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Signature Title ftidnk i
DOH-1555(07/18)p t of 2
1.
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#