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LaGurege, Robert M. Alpy NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert M.LaGurege Male Date of Death Age If Veteran of U.S.Armed Forces, 05/12/2020 51 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Sarah Mcmahon PA Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Villa a Albany 0101 1101 ❑Burial Date Cemetery,Crematory or Facility Name 05/16/2020 Pine View Crematory Entombment Address MCremation Queensbury Town,New York Donation Z �Removal Date Place Removed 0 and/or and/or Held H usHold Address O n. Date Point of N ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/15/2020 Registrar of Vital Statistics DanieCCe S GilTespie(ECectronicaC/y Signed (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition T/!'-ZoW Place of Disposition LU (address) W N (section) (lot nu ber) (grave number) Name of Sexton or Perso Charge o remises �� rInt) 93 Z (please print/ W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(72u)- a ) 13 8 2 " Receipt Human remains of delivered on , 20— # f J Pine View Cemetery ReTiresenting the-funeral home named on burial permit f Official Funeral Directors Reg.or License#.