Laidre, Tonn , _ % A01
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:,' Name First Middle Last Sex
Tonn Laidre Male
Date of Death Age ` If Veteran of U.S. Armed Forces,
09 / 17 / 2016 70 War or Dates N/A
}-: Place of Death Hospital, Institution or
Z City, Town or Village Wilton Street Address 8 Palmer Terrace
ILI
p Manner of Death t Natural Cause E Accident 0 Homicide El Suicide �Undetermined �Pending
In Circumstances Investigation
til Medical Certifier Name Title
John P. Mongan MD
Address
6 Medical Park Drive, Malta, NY 12020
i Death Certificate Filed District Number Register Number
City, Town or Village Wilton l92r�J //l
0ElBurial Date Cemetery or Cremat ry /
09 / 19 / 2016 Pine View Crematory
Li Entombment Address
CCremation Queensbury, NY
Date Place Removed
2❑Removal and/or Held
and/or Address
Hold
0 Date Point of
Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
:ix. Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
pi 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
2 Address
CC
iii
tu
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics 1/7/
Ik7/�fr/(ignature)
Mi District Number Place Wilton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
#- -
2
Ili Date of Disposition q/t 11i�, Place of Disposition ,iJic ) Cceradorptxd
X (address)
la
IC (section) �//(lot number) „ (grave number)
0 Name of Sexton or Person in Charge of P mises • l' (`<i � Si htI(
(pleElse print) •
W Signature Title plot
(over)
DOH-1555 (02/2004)