LoMonico, Lawrence :
NEW YORK STATE DEPARTMENT OF HEALTH 1 ' + j - 5xl
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lawrence LoMonico Male
Date of Death Age If Veteran of U.S. Armed Forces,
08 / 05 / 2015 76 War or Dates
}- Place of Death Hospital, Institution or
Z City, Town or Village Wilton Street Address 7 Shannon Way
0 Manner of Death Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending
ii! +`�' Circumstances Investigation
CI
ui Medical Certifier Name Title
0 David Mastrianni MD
Address
3 Care Ln, Ste 300, Saratoga Springs, NY 12866
ig Death Certificate Filed District Number Registe,& Number
City, Town or Village Wilton W-i� ,
ElBurial Date Cemetery or Crematory
08 / 07 / 2015 Pine View Crematory
El Entombment Address
+ Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
t❑Removal and/or Held
tio and/or Address
Hold
Ca
0 Date Point of
Transportation Shipment
L] by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
<; Name of Funeral Home Compassionate Funeral Care, Inc 00364
igli Address
402 Maple Ave., Saratoga Springs, NY 12866
iiig
Name of Funeral Firm Making Disposition or to Whom
le Remains are Shipped, If Other than Above
2 Address
1
1u
Permission is hereby granted to dispose of the human remains described abov as indjcated.
Date Issued Fief Registrar of Vital Statistics /4 d ! di
✓/ (signature)
District Number 66/ Place Wilton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
aDate of Disposition 'I'e1i$ Place of Disposition ...d.,✓ e +-
2 (address)
tit
0
CC (section) # ^(lot nu er) (grave number)
0 Name of Sexton or Perso in Charge of Premises ''
Z I (please print)
Signature Title '
(over)
DOH-1555 (02/2004)