O'Neil, Lawrence 3/1
NEW YORK STATE DEPARTMENT OF HEALTH 1 Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Lawrence P. O'Neil Male
Date of Death Age If Veteran of U.S.Armed Forces, �`>
I. April 29, 2015 61 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
o Manner of Death gi Natural Cause 0 Accident 0 Homicide 0Suicide 0 Undetermined El Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Dr. Joseph Mihindu, M.D. Dr.
Address
20 Murray Street, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls Z 3'
❑Burial Date Cemetery or Crematory
May 64, 2015 Pineview Crematorium
❑Entombment Address
if Q Cremation Town of Queensbury Queensbury, NY 12804
` Date Place Removed
0 ORemoval and/or Held
and/or Address
r Hold
ih Date Point of
0 ❑Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
6 0 Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
ii
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued ,5! t ` 5- Registrar of Vital Statistics CA)CA.Lr,--52--kA)--A-1\-cfM----.
(signature)
District Number ,fir`60 1 Place Glens Falls,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 05/04/2015 Place of Disposition Pineview Crematorium
2 (address)
W
if)
ft (section) ( t number) (grave number)
0 Name of Sexton or Person in Charge of Premises ., ,
Z Welke print)
W /,'
Signature Title C(tlzN1Ave.
(over)
DOH-1555 (02/2004)