Laubinger, Albert NEW YORK STATE DEPARTMENT OF HEALTH a'
• ., Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
,, Albert O. Laubinger Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 24, 2011 89 War or Dates
i-1 Place of Death Hospital, Institution or
_`- City, Town or Village South Glens Falls Street Address 9 Congdon Road
Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
, John P. Stoutenburg, M.D. Dr.
Address
102 Park Street Glens Falls NY 12801
Death Certificate Filed District Number �S�O� Register Number
City, Town or Village
�;•❑Burial Date Cemetery or Crematory
March 28, 2011 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
a and/or Address
Hold
Date Point of
NiTransportation Shipment
by Common Destination
' Carrier
Disinterment Date Cemetery Address
A. Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01097
Address
r; ; 136 Main Street, South Glens Falls NY 12803
f, Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
: Address
Permission is hereby granted to dispose of the human r ins described above äLLJJ
ndicated.
Date Issued 3 I:281 L/�t ,rn
j j Registrar of Vital Statistics Q . JJU
-
l (signature)
District Number 45-10,2 Place ( I 1--Jud json �'t . JU(A j 612!'1.5 Fa_w 11 y Iovo2
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/28/2011 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
• (section) (lot',giber) (grave number)
' c
Name of Sexton or Person in Ch e of Premises roc v P Je.Hrt'(�'
,Q 1 (please print)
Signature / ''� Title CriGl7ri--OL
A: 9
(over)
DOH-1555 (02/2004)