Lawrence, Timothy 7 .
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Timothy K.Lawrence Male
Date of Death Age If Veteran of U.S. Armed Forces,
pit 08/02/2018 59 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Le Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
r Circumstances Investigation
Medical Certifier Name Title
William Cleaver MD
te Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
IP C• ity, Town or Village Glens Falls 5601 372
ElBurial Date Cemetery or Crematory
08/07/2018 Pine View Crematory
14❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier _
• Disinterment Date Cemetery Address
• Reinterment Date Cemetery Address
It
Permit Issued to Registration Number
N• ame of Funeral Home Alexander Baker Funeral Home 00037
Address
3• 809 Main St,Warrensburg,New York 12885
kis Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/07/2018 Registrar of Vital Statistics cg6ertA Curtis(ECectronicaC(ySigned)
(signature)
District Number 5601 Place Glens Falls, New York
4-4
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition (gI g It Place of Disposition ,NI
- (address)
(section) (lot n betr) (grave number)
Name of Sexton or Person in Charge of remises rvt-upt_ s4414/1
(please print
Signature �j Title (044174,2..
(over)
DOH-1555 (02/2004)