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Trudeau, Lawrence 4 3.5,0 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle - Last Sex Lawrence E.Trudeau Male Date of Death Age If Veteran of U.S. Armed Forces, a 05/10/2018 80 Years War or Dates 1956-1961 Place of Death Hospital, Institution or City, Town or Village Elizabethtown Town Street Address Elizabethtown Community Hospital Manner of Death©Natural Cause El Accident 11 Homicide El Suicide El Undetermined El Pending X Circumstances Investigation Xi Medical Certifier Name Title Mary Halloran MD Address 75 Park Street PO Box 277,Elizabethtown Town,New York 12932 Death Certificate Filed District Number I Register Number City, Town or Village Elizabethtown 1552 38 ❑Burial Date Cemetery or Crematory 05/14/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed Removal and/or Held and/or Address Hold Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment 07- Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 Address 11 Algonkin St,Ticonderoga,New York 12883 A? 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 05/14/2018 Registrar of Vital Statistics Janet E Cross(Efectronicalty Signed) (signature) District Number 1552 Place Elizabethtown, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ! Date of Disposition CitChi Place of Disposition P,,,1. (r.0446ri... (address) (section) A (lot num (grave number) to Name of Sexton or Person in Charge of Premi es 144, i..•4 xi !t lease print) Signature 4 Title (?E'er (over) DOH-1555 (02/2004)