Oeinck, Larry Bird .t 37c
NEW YORK STATE DEPARTMENT OF H L'J
Vital Records Section Burial - Transit Permit
':' Name First Middle Last Sex
Larry Bird Deinck Male
Date of Death Age If Veteran of U.S. Armed Forces,
i05/07/2018 62 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
`1 Manner of Death® Natural Cause 0 Accident Ei Homicide p Suicide ri Undetermined Pending
Circumstances Investigation
, I Medical Certifier Name Title
in Carlos Ares MD
. : Address
' 211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 266
❑Burial Date Cemetery or Crematory
05/08/2018 Pine View Crematorium
❑Entombment Address
. ®Cremation Queensbury Town, New York
.. Date Place Removed
❑Removal and/or Held
and/or Address
g Hold
• a Date Point of
❑Transportation Shipment
G" by Common Destination
Carrier
i' Disinterment Date Cemetery Address
4..,
Reinterment Date Cemetery Address
Permit Issued to Registration Number
, Name of Funeral Home Carleton Funeral Home Inc 00281
I Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
t'g` Name of Funeral Firm Making Disposition or to Whom
6 Remains are Shipped, If Other than Above
2 Address
CC
LU
it Permission Is hereby granted to dispose of the human remains described above as indicated.
V'; Date Issued 05/08/2018 Registrar of Vital Statistics John PTran.-1,'EtctronicallySigned)
� , (signature)
District Number 4501 Place Saratoga Springs, New York
vq
1. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
0.1 Date of Disposition SJibulg Place of Disposition frviL, C,..fe—
(address)
uj
(section) (lot number) (grave number)
Name of Sexton or Person in Cha a of Premises Al- J
� d
se print)
. Signature Title Mon-yvt.
(over)
DOH-1555 (02/2004)