Lewis, Lynn Steven NEW YORK STATE DEPARTMENT OF HEALTH II Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lynn Stewart Lewis Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/07/2023 77 Years War or Dates Vietnam
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death a Natural Cause Accident Homicide Suicide ElUndetermined El Pending
W Circumstances Investigation
Medical Certifier Name Title
a Julian Marynczak PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 285
Burial Date Cemetery,Crematory or Facility Name
06/15/2023 Pine View Cemetery
Entombment Address
LiCremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
0
O. Date Point of
Cl)❑Transportation Shipment
Q by Common
Carrier Destination
o
Disinterment
Date Cemetery Address
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
Remains are Shipped,If Other than Above
a Address
Q
LL:
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/09/2023 Registrar of Vital Statistics 9tfegan No(n(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: \/
W
Date of Disposition j�. i 5 .a3 Place of Disposition pJ/ �uc k 2 Rd Li c nS 6u►" i VY /c @U�
(address)
c hic-Cu 3�f
N CC (section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises
Z (please print)
W Signature 444;4 41 Title .rsa t eY E'Jf'lt
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b)
012984
Receipt
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k 2..
Human remains of f yr)el U.,v.1+ ; delivered on , 20
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Pixie View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# t;{i r ,
KING
Lot No. 32
Address 339 Canada St. Lake George, N.Y. 12845 Section No. E
Owner Marion King Plot Mohican
Date 7/25/90
Approx. 67 Superficial ft. @
Location Bounded on North by Vacant, South by Path, East by Rocker & Dutra, West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 2294
Payment Record Paid in Full 7/25/90
Record of Interments (L
I 1 , nr q--V ,Lees 6.a� .�
2 Marion Grace King (6/30/2010) f
3
4
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5
6 /f X
7
8 I r>ctf-t ie' ees c f-reA-
Form No. 01
LEWISC•1" F)
NAME Lynn Steven Lewis Age: 77
Lot Owner: Marion King
Lot# Mohican 32 E Grave# 1
Case: Concrete
Died: 6.7.2 3 Interred: 6. 1 5.23
Funeral Home: Baker FH
Cemetery: Pine View