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Walker, Lawrence R rt- RKSTATE DEPARTMENT OF HEALTH NEW YO Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Male Lawrence R.Walker Date of Death Age If Veteran of U.S.Armed Forces, 05/28/2023 87 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Lake Luzerne Town Street Address 269 Hall Hill Road, Lake Luzerne Town, New York 12846 p Manner of Death Natural Cause IllAccident El Homicide ESuicide Undetermined ❑Pending UCircumstances Investigation W Medical Certifier Name Title 0 Noelle Stevens MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Lake Luzerne District Number Register Number City,Town or Village 5656 6 Burial Date Cemetery,Crematory or Facility Name 06/02/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,Warren,New York Donation Removal Date Place Removed and/or and/or Held - Hold Address 0 O. Date Point of CA❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/30/2023 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed) (signature) District Number 5656 Place Town Of Lake Luzerne I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition W(�(tj Place of Disposition W „AL__ (address) 111 (/) CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises lease print) Z IIZIr W Signature Title °DOH-1555(07/18)p i 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#