Lawrence, Thomas B NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas B Lawrence Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/10/2022 29 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address 23 Seward Street 12,Saratoga Springs,New York 12866
p Manner of Death Natural Cause Accident Homicide Suicide FlUndetermined riaPending
W Circumstances Investigation
W Medical Certifier Name Title
Eugene Ladue Coroner
Address
31 Woodlawn Ave.,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number •
City,Town or Village 4501 728
Burial Date Cemetery,Crematory or Facility Name
12/17/2022 Pineview Crematory
Entombment Address
aCremation Queensbury Town,New York
DDonation
goRemovalDate Place Removed
and/or and/or Held
F.:N Hold Address
0
O. Date Point of
(I) Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
EiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped,If Other than Above
2 Address
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Z Date of Disposition /Z/7Z,7Z Place of Disposition "--); ,.j C� )
(address)
W
CC CC (section) (lot number) 1 (grave number)
SName of Sexton or Person in Charge of mise
Z (please print)
W Signatures 6 Title
UU
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#