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Lawlor, William C
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William C.Lawlor Male Date of Death Age If Veteran of U.S.Armed Forces, 08/23/2021 87 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide Suicide ❑ Undetermined Pending W C.) Circumstances Investigation W Medical Certifier Name Title CI Jennifer White DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 468 ❑Burial Date Cemetery,Crematory or Facility Name 08/24/2021 Pine View Crematory Ei Entombment Address ElCremation Queensbury Town, New York Donation O ❑Removal Date Place Removed and/or and/or Held F- Hold Address 0 O. Date Point of (/) �Transportation CI Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address 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 H Remains are Shipped,If Other than Above a Address Et Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/24/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, 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 t— C ' _! Place of Disposition Pj n/e, V CV Uf Gvyiq/yey W (address) W CC (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises J (1141 P./' FAA;r-us Z //please print) W SignatureA- s Title G.r{�t�'►�^� DOH-1555(07/18)p 1 of 2 j Public Health Law Sec. 4145(2b) Receipt Human remains of ' '.; delivered on , 20 J ` I R he View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#