Lawson, Patricia Julia .,,, ,
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EW YORKSTATE DEPARTMENTOF HEALTH
Bureau of Vital RecordsBurial - Transit Permit
Name First Middle Last Sex
Patricia Julia Lawson Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/05/2022 68 Years War or Dates
F., Place of Death Hospital,Institution or
W City,Town or Village Fort Edward Village Street Address 115 Williams Road,Fort Edward Village,New York 12828
Q Manner of Death El Natural Cause Accident Homicide OSuicide Undetermined ❑Pending
VCircumstances Investigation
GMedical Certifier Name Title
William Parker MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 53
Burial Date Cemetery,Crematory or Facility Name
® 07/06/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
80 Removal Date Place Removed
and/or and/or Held
H Hold Address
W
0
IL Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
S Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/06/2022 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 7/4 In Place of Disposition Zat0---"2W /47:41...—
dress)
N
Q (section) (lot Humber) �l I,�(grave number)
gName of Sexton or Person in Cyr e of Premises At �°�I AMi
Z // (p! se print)
W Signature ! Title C'¢�mwzd✓�
DOH-1555(07/18)pi of 2
' eye,1 f:,n o.} it
1 Public Health Law Sec. 4145(2b)
1
1 Receipt
1
Human remains of delivered on , 20
1
1
1 Pine View Cemetery Representing the funeral home named on burial permit
1 Official Funeral Directors Reg.or License#