Zwick, Lawrence NFW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
`.:q Lawrence Joseph Zwick Male
Date of Death Age If Veteran of U.S.Armed Forces,
October 29, 2014 86 War or Dates
' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause n Accident n Homicide E Suicide n Undetermined C Pending
Circumstances Investigation
Medical Certifier Name Title
Address
- is b.�A I lc?ASS
'`� �istrict Number Register Number
{, Death Certificate Filed 1 g
5< City, Town or Village Glens Falls,NY 5601 L/97
®Burial Date Cemetery or Crematory
❑Entombment November 3,2014 Pine View Cemetery
Address
0 Cremation Quaker Road,Queensbury, ,NY 12804 -
Date Place Removed
Z E Removal and/or Held
and/or Address -
F' Hold
N
0 Date Point of
es C.Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
E
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address -
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10J`3 0) r y Registrar of Vital Statistics (/N70,n.l-yvt,k/0
(sip
District Number 5601 -gtt9Pri-
Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tuDate of Disposition 1 1 /3/201 4place of Disposition Pine View Cemetery
laMohican 28C (eddy ss)
N
0 (section) ((lot number
m Z Name of Se n or Person in Charge of Premises
onnie L. Goedert ) (grave number)
W (Please print)
1prSignature Title Superintendent
(over)
DOH-1555(02/2004)
ZWICK
L_IF) Lot No. 28
Address Roberts Garden No. Bldg 200 Apt, 3 Oueenshury, N_Y_ 17Rna Section No. C
Owner Mr. & Mrs. Lawrence J. Zwick Plot Mohican
Date 8/23/90
Approx. 100 Superficial ft. @
Location Bounded on North by Wilsey, South by Vacant, East by Kenney, West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 2309
Payment Record Paid in Full 8/23/90
Record of Interments
mwa:l.yr A Zwic h et. '.)
2 Lawrence Zwick ( 11 /3/2014 )
3
Casimir Tomanek 8/25/90 S
4
t. N
5 /}6 c/ S
N X C- C
7
8 .4) A) y
�j 3
Form No. 01
NAME ZWICK, LAWRENCE JOSEPH
Age: 86 L�
Cause: Natural j
Lot Owner:Lawrence J. Zwick
Lot # 28 C Mohican
Grave # 2
Case # Concrete
Died: 10/29/2014
Interred: 11 /3/201 4
Undertaker: Singleton, Sullivan & Potter