Fitzgerald, Lauren lisabeth OCOZ
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lauren Lisabeth Fitzgerald Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/29/2020 52 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Bolton Town Street Address 93 Mohican Road,Bolton Town,New York 12814
Manner of Death Undetermined Pending
W EI Natural Cause Accident Homicide Suicide
Circumstances Investigation
WMedical Certifier Name Title
Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed District Number Register Number f
City,Town or Village Bolton Landing 5650 14
11 Burial Date Cemetery,Crematory or Facility Name
12/31/2020 Pine View Crematory
❑Entombment Address
iCremation Queensbury,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
0
1-1 Date Point of
to ❑Transportation
Q by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number ,
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/31/2020 Registrar of Vital Statistics Jodi L Connaty(Ekctronicall:y Signe?
(signature)
District Number 5650 Place Bolton Landing, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition I/I IZi Place of Disposition Z 1LILI
,
(address)
W
N 0 (section) lot number) (grave number)
L,G Name of Sexton or Person in Charge Premises t'` tM
(plea4print)
Z
W Signature Title 0 ``113it
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) 0 1 El 6
Receipt
Human remains of delivered on , 20
e View Cemetery epresenting the funeral home named on burial permit
fficial Funeral Directors Reg.or License#