McLaughlin, Edward nsi /
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section IrkBurial - Transit Permit
Name First Middle Last Sex
Edward Gregory McLaughlin Male
Date of Death Age If Veteran of U.S, Armed Forces,
August 27,2013 65 War or Dates
.. Place of Death Hospital, Institution or
Z City,Town or Village Lake Placid Street Address 20 Elm St.
wp Manner of Death X Natural Cause Accident I !Homicide Suicide Undetermined Pending
W Circumstances Investigation
u Medical Certifier Name Title
G Francis W.Whitelaw,Coroner
Address
60 Maple Lane,Bloomingdale,NY 12913
Death Certificate Filed District Number Register Number
City,Town or Village. Village of Lake Placid 1523 /7
❑Burial Date Cemetery or Crematory
D Er>torr�ment August 30,2013 Pine View Crematory
Address
®Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
H Hold
to
0 Date Point of
N Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
(—}Rein#erment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Clark,Inc. 01075
Address
2310 Saranac Ave.,Lake Placid,NY 12946
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
X Address
Cd
ut
a.
Permission is hereby granted to dispose of the human rema- des ribe above as indicated.
Date Issued 08-29-2013 Registrar of Vital Statistics f ift( (elf
(sigdature)
District Number 1523 Place Village of Lake Placid
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition q j 3 I t3 Place of Disposition f 4ktl./tt v C rwwctor;4,—
W (address)
Cl)
CC (section) (lot umber) (grave number)
pName of Sexton or Person i Charge of P emises `It f •�1„NI4
Z (P se Print)
W Signature IL-
L Tide c
(over)
DOH-1555(02/2004)