Durkee, Lawrence EA TH Burial - Transit Permit
NEW YORK STATE DEPARTMENT OF H L Sex
Vital Records Section Last male
Name First Middle
Lawrence Beecher
AgeDurkee .I If Veteran of U.S. Armed Forces,
Date of Death \ War or Dates
Jul 25 1 998 Hospital, Institution or
Place of Death Street Address Glens Falls Hosiital Pending
Glens Falls Suicide Undetermined ❑Investigation
Manner of h Accident Homicide Circumstances
0; Manner of Death r Natural Cause
": Medical Certifier Name Title
Ste•hen Monn MD
Address
•
92 Broad Street Glens Falls NY 12801strict Number
Register Number
i.
`'�< Death Certificate Filed 5601
City,XIHIW4�( D( K � Glens Falls Cemetery or Crematory
Date pine View Cemeter
Jul 29
1998
®Burial Address
Quaker Ruad Queensbur NY 12804_
( rematic!n Place Removed
Date and/or Held
2 Removal
'It,❑and/or Address
HoldIP
Point of
Date N Shipment
❑Transportation
: by Common Destination
Carrier Cemetery Address
Date
Disinterment
Date Cemetery Address
Reinterment Registration Number
<: Permit Issued to 01565
Name of Funeral Home Re•an and Denn Funeral Home
Di Address
Nli 52 Quaker Road, Queensbur , NY 12804
11 Name of Funeral Firm Making ngrDisposition than Abone or to Whom
Remains are Shipped,
If Address
a&. bgranted to dispose of the human remains de cribed above as' d' a ed.
Permission is here y i)
5Date Issued 2 Registrar of Vital Statistics (signature)
District Number S Q
Place G Lam- 2
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
6Date of Disposition 2 9 9 8 Place of Disposition PView
ew Cemeter u e e n s b u r N
7 (address)
ig
28
Free Ground
N (section)
lot number) (grave number)
C Name of Sext.• e Person in ...
Charge of Premises Rodney G . Mosher
(please print)
." Title Superintendent
#Ji gignatur: ua. 1• l-- -"°_'�:.
DOH-1555 (10/89) p. 1 of 2 VS-61