Woodard, Lawrence NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lawrence Emery Woodard Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 1, 2012 83 War or Dates
. Place of Death Hospital, Institution or
City, Town or Village Johnsburg, NY Street Address 327 River Road
US
rz Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
tifCircumstances Investigation
Medical Certifier , 1Name �\ Title
ig, WA\�C`,.rY.. Qr\4l, p�
Address '
Death Certificate Filed v District Number Register Number
• City, Town or Village Johnsburg,NY cS 6 S
❑X Burial Date Cemetery or Crematory
December 6, 2012 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, , NY 12804
Date Place Removed
ZZ I 'Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
: 1 Name of Funeral Home Regan& Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
g.4 Remains are Shipped, If Other than Above
gAddress
Permission is hereby granted to dispose of the human remains described ab as indicated.
• Date Issued /2 `/ ?oi Z Registrar of Vital Statistics1 (signature)
District Number �6 5 S-- Place Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1 2-6-1 2 Place of Disposition Pine View Cemetery
2 (address)
W
en Erie 56 A 1
(section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises Michael Genier
Z (please print)
W Signatures' Title Superintendent
(over)
DOH-1555(02/2004)