Holstein, Lynne Gail NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lynne Gail Holstein Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/24/2022 77 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W Manner of Death Undetermined nPending
O ri Natural Cause Accident n Homicide Suicide n I I
lL Circumstances Investigation
U Title
W Medical Certifier Name
CI Kevin Dooley MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 767
Burial Date Cemetery,Crematory or Facility Name
12/27/2022 Pine View Cemetery and Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
- and/or and/or Held
H- Hold Address
N
0
Date Point of
(I)❑Transportation Shipment
p by Common
Carrier Destination
nDisinterment
Date Cemetery Address
Date Cemetery Address
nReinterment
Permit Issued to Registration Number
Name of Funeral Home William J Burke&Sons Funeral Home 01827
Address
628 N Broadway,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2022 Registrar of Vital Statistics Dillon Moran(ECectronicatty Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition /Z-2 fj-2.'7Z Place of Disposition Ride 14.4,4) L t.nrl4seh
W
N (section) (lot number) (grave number)
CC
Name of Sexton orPersoninChargeis �4)M?sb li v
dd
z Q of Prem (please print)
LU Signature 1� � /417 Title G`�f}�+ �
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 burial permit
fficial Funeral Directors Reg.or License#