LaBar, Clare lic ..>' '2/ __.--'
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section R
Name First Middle Last Sex
Clare L. LaBar Female
Date of Death Age If Veteran of U.S.Armed Forces,
June 23,2006 72 War or Dates
Place of Death Hospital, Institution or
ZCity,Town or Village City of Glens Falls Street Address Glens Falls Hospital
IIJ G Manner of Death 0 Natural Cause El Accident El Homicide ❑ Suicide El Undetermined ❑ Pending
Circumstances Investigation
V Medical Certifier Name Title
W CIAmy Hogan Physician
Address
Two Broad Street,Glens Falls,NY 12801-
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls 5601 2.9 7
0 Burial Date Cemetery or Crematory
6/26/2006 Pine View Crematorium
❑ Entombment Address
0 Cremation Queensbury,NY
Date Place Removed
z ❑ Removal and/or Held
p and/or Address
F Hold
ao Date Point of
❑ Transportation Shipment
N by Common Destination
G Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Alexander Funeral Home,Inc. 00037
Address
4479 State Route 28,North River,NY 12856
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped, If Other than Above
Address
IX
pW„ Permission is hereby granted to dispose of the human remains descri a v a ' i
Date Issued 06/26/06 Registrar of Vital Statistics �
(signature)
District Number 5601 Place City of Glens Falls Clerk,City Hall,Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— o L Y
Z Date of Disposition L-i Place of Disposition r AIA1 u.r Crt,,.,c1-G r, d t.►.
W (address)
2
W
co (section) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises C t r'-.+ e r«.y r1--
Z (please print)
W Signature � � Title Cet ,- e
DOH-1555(02/2004) (over)