Stephens, Lawrence NEW YORK STATE DEPARTMENT OF HEALTH
I )
Vital Records Section Burial - Transit Permit
' Name First Middle Last Sex
LAWRENCE CHARLES STEPHENS MALE
Date of Death Age If Veteran of U.S.Armed Forces,
09/13/2013 75 War or Dates YES
Place of Death Hospital, Institution
Z C• ity ,Town or Village City of Albany or Street Address ST. PETER'S HOSPITAL
GManner of Death Natural Undetermined Pending
W ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
11 M• edical Certifier Name Title
P. NILOO M. EDWARDS MD
Address
319 S MANNING BLVD., ALBANY NY 12208
ti Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1749
Date Cemetery or Crematory
❑ Burial 09/16/2013 PINEVIEW CREMATORY
❑ Entombment Address
®Cremation QUEENSBURY, NY
Date Place Removed
Z ❑ Removal and/or Held
and/or Address
P Hold
U/)
Date Point of
pa Transportation Shipment
N; ❑ By Common Destination
Carrier
0 Disinterment Date Cemetery Address
El Reinterment
Cemetery Address
Reinterment
Permit Issued To Registration Number
r Name of Funeral Home COMPASSIONATE FUNRAL CARE INC 00364
Address
402 MAPLE AVE., SARATOGA SPRINGS NY 12866
Name of Funeral Firm Making Disposition or to Whom
t_-, Remains are Shipped, If Other than Above
Address
iti
44, Permission is hereby granted to dispose of the human remains des "bed above as indi d.
Date 09/16/2013 1.4S
Issued Registrar of Vital Statistics i
(signature)
` District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition Cll1�113 Place of Disposition 2ru1Lvi_i t 10r,*--
(address)
W
u)
te (section) (lot nu er) (grave number)
0
0
W• Name of Sexton or Person in Charge of Premises C►y1 f for fnr[jq
(please print)
Signature7 Title C/2 +1Y111?
(over)
DOH-1555(02/2004)