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Lawrence, Barbara E.
, ' • - . Pt 3°3 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit 0 Name First Middle Last Sex Barbara E.Lawrence Female Date of Death Age If Veteran of U.S.Armed Forces, 03/24/2021 83 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 227 Lamplighter Acres, Moreau Town, New York 12828 W Manner of Death Pending � ©Natural Cause �Accident �Homicide �Suicide �Undetermined � W U Circumstances Investigation W Medical Certifier Name Title CI Mark Quaresima MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 18 ❑Burial Date Cemetery,Crematory or Facility Name 03/25/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York Donation . g ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 O. Date Point of fA Li Transportation Shipment p by Common Carrier Destination 0 Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 1- Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/25/2021 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: � � ~ � ✓t.. Z Date of Disposition 31 j(a I Z 1 Place of Disposition W (address) LU CCCC (section) / ° ; L umbe (grave number) 0NameofSextonorPersoninChargeofPre ' es r� t Z 11 (please pit) W !/ / _� Title �1U'r�1 � Signature DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) =i7 it I.6 '9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on,burial permit Official Funeral Directors Reg.or License#