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Webster, Larry NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial _ Transit Permit Name First Middle Last Sex Larry Gordon Webster Male Date of Death Age If Veteran of U.S. Armed Forces, July 23, 2015 74 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address 51 Prospect Street iii Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation g Medical Certifier Name Title gi Robert Love,MD ;:. Address :; Glens Falls,NY Death Certificate Filed District Number Register4luqob City, Town or Village Glens Falls, NY 5601 0 Burial Date Cemetery or Crematory July 27, 2015 Pine View Cemetery ❑Entombment Address ❑Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address ! Hold cn 0 Date Point of O. Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number :i:;f Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above gAddress Permission is hereby granted to dispose of the human remains d scri ed bo indicated. Date Issued ©?�L3/2O/J Registrar of Vital Statistics 1' (signature) District Number `j 620/ Place IiiAA, /X I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition 7/27/ 1 15 Place of Disposition Pine View Cemetery, Queensbury, NY 2 (address) W N Erie 62A 1 W (section) (lot number) (grave number) p Name of Se n or Person in Charge of Premises Connie L. Goedert Z (please print) w Signatur ' .Bt'Lu1 e. D Title Cemetery Superintendent (over) DOH-1555(02/2004)