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Lauzon, Stephen paul NEWYORKSTATE DEPARTMENTOF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Stephen Paul Lauzon Male Date of Death Age If Veteran of U.S.Armed Forces, 12/28/2019 61 Years War or Dates 1978-1980 Place of Death Hospital,Institution or City,Town or Village Johnsburg Town Street Address 191 Main Street,Johnsburg Town,New York 12853 p Mannerof Death Natural Cause ©Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 52 Burial Date Cemetery,Crematory or Facility Name 01/03/2020 Pine View Crematory Entombment Address aCremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held F-N Hold Address O 0. Date Point of to Transportation p by Common Shipment Carrier Destination 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 F— Remains are Shipped,If Other than Above 2 Address IX W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/31/2019 Registrar of Vital Statistics rothCeen C.Gorah(Efectronicaffy Signed (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 3 j 10 Place of Disposition L 4w car.` W (address) W N (section) (lot number) (grave number) Name of Sexton or Person in Charge f Premises ( NCI Z (pl se print/ W Signature Title DOH-1555(07/18)p 1 of 2 I I Public Health Law Sec. 4145(2b) - - ° - Receipt Human remains of i - - �, delivered on , 20 a Pine View Cemetery Represefiting the funeral home named on burial permit Official Funeral Directors Reg.or License#+, ' r' I i i i