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Lawrence, William T
(LF1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William T Lawrence Male Date of Death Age If Veteran of US.Armed Forces, 01/19/2024 69 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 18 Donna Avenue,Moreau Town,New York 12803 I111 ll Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide [ Undetermined ri Pending Circumstances Investigation W Medical Certifier Name Title G Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 7 Burial Date Cemetery,Crematory or Facility Name 01/22/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation Removal Date Place Removed and/or and/or Held • Hold Address i 0 Date Point of Transportation Shipment ZS by Common Carrier Destination Disinterment Date Cemetery Address D Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1.... Remains are Shipped,If Other than Above 5 Address IL w • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics Brenda 2futter(ECectronical(y Signed) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition I 12) t i Place of Disposition -r s.4 -J (Ps 44Gu .1-- W (address) w NCr (section/ j) (lot number) (grave number)Q GCjj/"11 T.t'D_ 'fl O Name of Sexton or Person in Charge of Premise }a z (p/ se prim W Title irf mt‘�+i Signature DOH-1555(07/18)p 1 of 2 0 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#