Roccasecca, Laura NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Laura Lee Roccasecca Female
ei Date of Death Age If Veteran of U.S. Armed Forces,
10/18/2018 56 Years War or Dates
E4 Place of Death Hospital, Institution or
6 City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death El NaturalCause ❑Accident Homicide El Suicide Undetermined Pending
Circumstances Investigation
tu Medical Certifier Name Title
i Matthew Loftus PA
:'� Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Numberui
a. City, Town or Village Glens Falls 5601 1
0Burial Date Cemetery or Crematory
10/19/2018 Pine View Crematorium
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Hold Address
CO
2 Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:, Permit Issued to Registration Number
ii Name of Funeral Home Carleton Funeral Home Inc 00281
Address
1- 68 Main Stpo Box 67,Hudson Falls,New York 12839
2 Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
2 Address
CC
ILI
Ei Permission is hereby granted to dispose of the human remains described above as indicated.
.,,, Date Issued 10/19/2018 Registrar of Vital Statistics Rv ert,.4 Oatrs(Et ct ornr arrySigned)
(signature)
,; District Number 5601 Place Glens Falls, New York
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition (D I zi ri Place of Disposition 11',,VA-... G I
(address)
Cl)Uni
(section) (lot number) ei (grave number)
0 Name of Sexton or Person in Charge of Prem. es ^'') i��,.�
Z iii (please print)iiASignature Title t'fifM
(over)
DOH-1555 (02/2004)