Lawrence, Mary -It 114
NEW YORK STATE DEPARTMENT OF HEALTH e
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary E. Lawrence 1 Female
Date of Death Age ' If Veteran of U.S. Armed Forces,
March 25, 2012 67 War or Dates
. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls H Mal
ciManner of Death I XI Natural Cause I !Accident I 1 Homicide Suicide Un .&ermined Pending
W C' umstances Investigation
nj; Medical Certifier Name Title
: Marvin Davidowitz,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
: City, Town or Village Glens Falls,NY 5601 i ) ag"
❑Burial Date Cemetery or Crematory
El Entombment March 28, 2012 Pine View Crematory
Address
Ni Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z [ l Removal and/or Held
2 and/or Address
t" Hold
0 Date Point of
Di I 1 Transportation I Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Date
j Reinterment Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01443
Address
"° 53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
h Remains are Shipped, If Other than Above
.' , Address
,t4
tiS
:C4 Permission is hereby granted to dispose of the human remains described above as indicated.
H` Date Issued 3/ .6// Z. Registrar of Vital Statistics C� C '- R.
(signature)
'` District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposedd of,in accordance with this permit on:
LuDate of Disposition 3--0-IL Place of Disposition -t',....sA ... rew-dwr,u..
IA (address)
CD
LY
0 (section) /1 (lot num.) (grave number)
p Name of Sexton or Person in Char of Premises //t.14 t ,y,t"
Z (please print)
W
Signature Title CQeM r} f)t
(over)
DOH-1555(02/2004)