LaPoint, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth "Betty" LaPoint Female
Date of Death Age If Veteran of U.S.Armed Forces,
F December 13, 2006 92 War or Dates
z Place of Death Hospital, Institution or
W City,Town,or Village Queensbury Street Address Stanton Nursing & Rehabilitation
G Manner of Death x❑ Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑ Undetermined E Pending
W Circumstances Investigation
() Medical Certifier Name Title
W Dr. Roslyn Socolof, M.D. Dr.
Q Address
100 Broad Street, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury SkoS---) )c2g
❑X Burial Date Cemetery or Crematory
December 16, 2006 Mount Hermon Cemetery
-El Entombment Address -
❑Cremation Queensbury, NY 12804-
Date Place Removed
0 ❑ Removal and/or Held
and/or Address
Hold
0 Date Point of
0 E Transportation Shipment
A by Common Destination
i Carrier
Date Cemetery Address
a ❑Disinterment
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01141
Address
136 Main Street, South Glens Falls, New York 12803
F Name of Funeral Firm Making Disposition or to Whom
ft ft Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby granted to dispose of the human rem ins described above as,itnd ated.
Date Issued i 2-//Syo C Registrar of Vital Statistics
(signature)
District Number Sta S- Place Queensbury,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 12/16/2006 Place of Disposition Mount Hermon Cemetery
2
2 (address)
0 FAMILY PLOT
It
It (section) (lot number) (grave number)
C Name of Sexton or Person in Charge of Premises M I C H A E L G EN I ER
W (please print)
Signature93.4.Aa.;,.^.. Title S U P T
(over)
DOH-1555 (02/2004)