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Langr SR.,Frank W NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frank W.Langr Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 09/02/2021 87 Years War or Dates Korean Place of Death Hospital,Institution or Z City,Town or Village Lake Luzerne Town Street Address 974 E River Drive, Lake Luzerne Town, New York 12846 W CI Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation V W Medical Certifier Name Title CI Kevin Dooley MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Lake Luzerne 5656 13 ElBurial Date • Cemetery,Crematory or Facility Name 09/04/2021` Pine View Crematory El Entombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held W Hold Address 0 d Date Point of N ❑Transportation ES by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address 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 Remains are Shipped,If Other than Above 5 Address Cr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/03/2021 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed) (signature) District Number 5656 Place Lake Luzerne, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W � p?Date of Disposition - ,' Place of Disposition Pv a� ��`> l�rtap f� 2 (address) W to (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premis ---PAV pgor>cl C. ijcan!1 Z i (please print) W Signature Title 0���t 7" DOH-1555(07/18)p i of 2 4 . ,t 1 1 q ' 1 1 5- ,.. ,- 1., _ .?. Public Health Law Sec. 4145(2b) Receipt Human remains of s, �j' . o' `6' delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,' r :{`