Lincoln-Lynch, Jonathan R `\ # /c--
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NEW YORK STATE DEPARTMENT OF HEALTH \-,...____-'' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jonathan R.Lincoln-Lynch Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/19/2022 32 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 222 Meadowbrook Road Q,Queensbury Town,New York 12804
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Manner of Death 0 Natural Cause Accident Homicide ESuicide DUndetermined rid Pending
Circumstances Investigation
gMedical Certifier Name Title
�3 Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 1 5657 , 180
Burial Date Cemetery,Crematory or Facility Name
11/21/2022 Pineview Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Q❑Removal. Date Place Removed
and/or and/or Held
F' Hold Address
2 Date Point of
(ft Transportation Shipment
ZS by Common
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
\11 Reinterment
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
F. Remains are Shipped,If Other than Above
5 Address
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CL` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/21/2022 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
10. -I� v /. _._.
ILIDate of Disposition Jf�2Z�22 Place of Disposition ,;11 ,_
X (address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premi s Cyr"1,,pL_ c n
please print)
Ili ire
Signature Title �� '�
DOH-1555(07/18)p 1 of 2
,1I612
Public Health Law Sec. 4145(2b)
Receipt
I
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named drrbutal,perrrit
Official Funeral Directors Reg. or License#