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Parsons, Tom Franklin . .Iiia NEW YORK STATE DEPARTMENT OF HEALTH x Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Tom Franklin Parsons Male Date of Death Age If Veteran of U.S.Armed Forces, 02/22/2022 81 Years War or Dates 1959-1962 Place of Death Hospital,Institution or Z City,Town or Village Lake Luzerne Town Street Address 43 Howe Road, Lake Luzerne Town, New York 12846 pManner of Death ©Natural Cause Accident Homicide Suicide El Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI George Siniapkin MD Address 604 Palmer Avenue,Corinth Town,New York 12822 Death Certificate Filed District Number Register Number City,Town or Village Lake Luzerne 5656 4 0 Burial Date Cemetery,Crematory or Facility Name 02/23/2022 Pine View Crematory ElEntombment Address ElCremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held F. Hold Address N 0 O. Date Point of Cl) u Transportation p by 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 �.- Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2022 Registrar of Vital Statistics Ointlra9'IB'WG i(ElfflrCDllCtyly3g1e3) (signature) District Number 5656 Place Lake Luzeme, 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 2124 122 Place of Disposition4,1�, r;_., W 2 (address) IW CC (section) /lot number) (grave number) 8 Name of Sexton or Person in Charge of Premi I{ h44fi (p14e print) W Signature Title tfirvit DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#