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Lawlor, Daniel Patrick
.- . , ii5-ta NEW YORK STATE DEPARTMENT OF HEALTH _ , Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel Patrick Lawlor Male Date of Death Age If Veteran of U.S.Armed Forces, 10/09/2021 74 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU p• Manner of Death © Natural Cause ❑Accident Homicide 0 Suicide ❑Undetermined 0 Pending U Circumstances Investigation W Medical Certifier Name Title Ca Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 $ Death Certificate Filed District Number Regist ue .r City,Town or Village Glens Falls 5601 446 / Burial Date Cemetery,Crematory or Facility Name 10/12/2021 Pine View Crematory 0 Entombment Address ElCremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of (p Li Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/12/2021 Registrar of Vital Statistics Men Andrew Curtis(E(ectronicalry Signed) (signature) District Number 5601 Place Glens Falls, 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 /O../'3-2,02-/ Place of Disposition i�ih l✓1", C Pe.. ar 7 1l.1 (address) W Cl) (section) (lot number) (grave number) CC O Name of Sexton or Person' Charg f Premises �4ti 1^�.rl A441 ��i 1 z (please print) W Signature Title C <2rNG7l a ry ,64pc,-- d-'"' DOH-1555(o7/i8)p 1 2 I •,„- . • Public Health Law Sec. 4145(2b) ..., ,,,,,.‘,./‘,..,.......„. Receipt •, ,, ,, ,e -, Human remains of ._ ': t '.- ' '`. i — delivered on• ', 1 /.../ — , 20 ..• „, .. 7 i f,'-',,°, 1.. s'''' ' L. Rime View Cemetery Representing the funeral h'ome named on buriai p 't ,'Official / ,— ,,,--- Funeral Directors Reg.or License# • 0.- '