Savage, Lawrence NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lawrence Francis Savage Male
Date of Death Age If Veteran of U.S.Armed Forces,
October 1,2012 61 War or Dates
i.. Place of Death Hospital, Institution or
Z City, Town or Village Lake Placid Street Address 89 Greenwood St.
tp Manner of Death Natural Cause n Accident Q Homicide n Suicide FlUndetermined n Pending
Circumstances Investigation
G Medical Certifier Name Title
Elizabeth Bartos,MD
Address
Church St.,Lake Placid,NY 12946
Death Certificate Filed District Number Register Number
City, Town or Village Village of Lake Placid 1523 $2
❑Burial Date Cemetery or Crematory
Entvinbment October 3,2012 Pine View Crematory
Address
NI Cremation 4 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZO Removal and/or Held
and/or Address
N Hold
0 Date Point of
N Li Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
1-1 Reinterment 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
H Remains are Shipped, If Other than Above
2 Address
a. Permission is hereby granted to dispose of the human remai des ibed bove as indicated.
Date Issued 10-2-2012 Registrar of Vital Statistics t(te/,C
(signe)
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:
w Date of Disposition /0/3'i2 Place of Disposition '(�.,.Uuv (.r fvw fon
(address)
tu
to
(section) Q�o°t number) c�' (grave number)
p Name of Sexton or Person in Charge o Premises Ir i'�iplr.. Jt l�
'(please print)
W Signature4 Title CR ,n(}
(over)
DOH-1555(02/2004)