Lord, Daniel Edward NEW YORKSTATE DEPARTMENT OF HEALTH , LFBurialBureau of Vital Records _ Transit Permit
Name First Middle Last Sex
Daniel Edward Lord Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/16/2022 52 Years War or Dates
F., Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 932 State Rte 9 Route 113,Queensbury Town,New York 12804
W
p Manner of Death 0 Natural Cause Accident n Homicide Suicide Undetermined []Pending
UCircumstances I 'Investigation
al Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue, Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 190
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town, New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
U)
0
Q. Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
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
_
Address
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/19/2022 Registrar of Vital Statistics Caroline JfiCdegarde Barber(ECectronica1TySigned)
(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:
I—
Z Date of Disposition 12.14 I IL Place of Disposition f�,_ (7. A,,_
W
2 (address)
W
U)
CC (section) /) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises 1. `yft
Z (p!ase print)
ll! Signature 7!)
---. Title �rt6rrlH?Yr
DOH-1555(07/18)p 1 of 2
I. . l65
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#