Lamb, Michael Edward it (,63
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Male
Michael Edward Lamb
Date of Death Age If Veteran of U.S.Armed Forces,
08/29/2022 75 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Lake George Village Street Address 2 Hammond Street,Lake George Village,New York 12845
W Manner of Death Undetermined ❑Pending
0 Natural Cause Accident Homicide Suicide
Circumstances Investigation
0 Title
0IIJ Medical Certifier Name
Donald Merrihew MD
Address
319 Bay Road,Queensbury Town,New York 12804
Death Certificate Filed Village Of Lake George District Number Register Number
City,Town or Village 5620 04
Burial Date Cemetery,Crematory or Facility Name
08/31/2022 Pine View Crematory
Entombment Address
IICremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held -
H Hold Address
N
0
•
Date Point of
N❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
0 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
F 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 08/31/2022 Registrar of Vital Statistics De6ra39,ickinney(ECectronica(TySignet0
(signature)
District Number 5620 Place Village Of Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
W Date of Disposition Q13)1 TZ Place of Disposition Fn.IL
4----.
2 (address)
W
CC (section) (lot number) (grave number)
O Name of Sexton or Person in Char e of Premises • % e
roll— i
Z (lease print)
WZi7
Signature -c--- Title l`PC/7% L
,IIIIIIMMI
OOH-r555(o7/18J P I of 2
6200
Public Health Law Sec. 4145(2b)
Receipt
Human remains of L delivered on , 20
F
Pine View Cemetery Repre'senting the funeral home named-obu.rial„permit
Official Funeral Directors Reg.or License# '
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