Masse, Laurence 1
At
NEW YORK STATE DEPARTMENT OF HEALTH ZSo
Vital Records Section Burial - Transit Permit
<! Name First Middle Last Sex
Laurence R. Masse Male
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 25 / 2017 78 War or Dates 1961-1963
}- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Wesley Health Care Center
etManner of Death®Natural Cause Accident Homicide 0 Suicide Undetermined �Pending
Circumstances Investigation
tu Medical Certifier Name Title
44 D c E U3Q� b�K NP
Address
►31 Lauxemce S I c a Sp i N ' Z�lo
>' Death Certificate Filed District Number Register Nu
City,Town or Village Saratoga Springs ySb
! In Burial Date Cemetery or Crematory 0
03 / 27 / 2017 Pine View Crematory
:>:BEntombment Address
ECremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
0
Hold
44 Date Point of
Q Transportation Shipment
a by Common Destination
Carrier
'> ID Disinterment Date Cemetery Address
[I Reinterment Date Cemetery Address
«` Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
.> Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
it
Iu
Permission is h reby granted to dispose of the human remains-de- ri d abopp 'ndicate
'` Date Issued Registrar of Vital Statistics i
(signature)
:. District Number St)/ Place Saratoga Springs , New York
1-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on;
ILI Date of Disposition � z�r /7 Place of Disposition � � y
ILI
(address)
fil
l (section) l / (lot n bar) (grave number)
Name of Sexton or Per ge of Premise/,c____—s 3 1 1'` ( , (..,, �CcG�...,e
z (please print) •
L Signature Title C-� � �.
(over)
DOH-1555 (02/2004)