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Lautenschuetz, Roger P r _ L 11 61 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Roger P. Lautenschuetz Male Date of Death Age If Veteran of U.S.Armed Forces, 08/04/2023 79 Years War or Dates 1—. Place of Death Hospital,Institution or WCity,Town or Village Coxsackie Town Street Address 11260 Rt 9 W,Coxsackie Town, New York 12051 p Manner of Death El Natural Cause Accident 0 Homicide OSuicide FlUndetermined ❑Pending W U Circumstances Investigation Ill 0 Medical Certifier Name Title Gerard Buckley Coroner Address 411 Main Street,Catskill Town,New York 12414 Death Certificate Filed Town Of Coxsackie District Number Register Number City,Town or Village 1954 17 Burial Date Cemetery,Crematory or Facility Name 08/07/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0 Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of Cl) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 H Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/07/2023 Registrar of Vital Statistics Bambi Hotaling(Electronically Signed) (signature) District Number 1954 Place Town Of Coxsackie I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition $igl7.5 Place of Disposition [,/� 2 (address) W U) Q (section) /� (lot number) (grave number) GName of Sexton or Person in Charge of Premises d �✓ Z (p. se print) tU Signature Title (2(71%q71)2 DOH-1555(07/18)p 1 of 2 +- _ � � m.. ;.t Public Health Law Sec. 4145(2b) 3 �, Receipt Human remains of delivered on , 20 ` Pine VIM'cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#