LaPier, Dennis . 1 t 5a5
NEW YORK STATE DEPARTMENT OF HEALTH -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dennis P. LaPier Male
Date of Death Age If Veteran of U.S.Armed Forces,
August 4, 2014 56 War or Dates No
F-= Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address Albany Medical Center
0 Manner of Death Natural Undetermined Pending
I,FI', ® Cause El Natural ❑ Homicide El Suicide ❑ Circumstances ❑ Investigation
WMedical Certifier Name Title
Boris Shrolnik MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1464
Date Cemetery or Crematory
❑ Burial August 5, 2014 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
❑ and/or Address
I-- Hold
N'
Qi Date Point of
p. Transportation Shipment
N ❑ By Common Destination
0 Carrier
❑ Disinterment Date Cemetery Address
❑ Date Cemetery Address
Renterment
--4q Permit Issued To Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
Address
24 Church Street, Lake Luzerne, NY 12846
Name of Funeral Firm Making Disposition or to Whom
N Remains are Shipped, If Other than Above
* Address
1,
Ili Permission is hereby granted to dispose of the human remains described abov as indicated.
• Date August 4, 2014 ` �xi
Issued Registrar of Vital Statistics (signatu e) f
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accord e with this permit on:
li ''II+r /7
Date of Disposition 6)IcJIN Place of Disposition ft ' L1tr. ,%--
W (address)
w
to
IX (section) (lot number) (grave number)
0
O �!
Name of Sexton or Person in Charge of Premises Ni
tti (please print)
Signature_____________/ZTitle azisitiVi
(over)
DOH-1555 (02/2004)