Thompson, Lisa Ann _ —)L10
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lisa Ann Thompson Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/13/2023 60 Years War or Dates _.
Place of Death Hospital,Institution or
Z City,Town or Village Warrensburg Town Street Address 47 River Street,Warrensburg Town,New York 12885
Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
0 Hilary Jones NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 13
Burial Date Cemetery,Crematory or Facility Name
09/14/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
a Date Point of
(J)ElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/13/2023 Registrar of Vital Statistics Pamela M Lloyd(Electronically Signed)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 911417,,4 Place of Disposition
W
2 (ad ress)
W
CC CC (section) (lot number) (grave number)
gName of Sexton or Person in Charge of Pre ises
Z (p ase print) j
W Signature Title l P''elhiT
DOH-1555(07/18)p 1 of 2
g�-yyyy
!� 1 rti 2 I. P 3"..y R
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#