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LaPoint, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH • .4 A Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elizabeth Lorraine TaPoint female • Date of Death Age If Veteran of U.S. Armed Forces, War or Dates Feb 9 2011 I 85 -0- Place of Death Hospital, Institution or City, Town or Village Johnsburg Street Address Adirondack Tri County Nursing Dome Manner of Death®Natural Cause El Accident 0 Homicide 0 Suicide n Undetermined r7 Pending Circumstances Investigation Medical Certifier Name Title 11 Dean Rcali, DO Address l- North Creek, NY Death Certificate Filed District Number �- Register Number r City, Town or Village Johnsburg cS e b /0 ❑Burial Date Cemetery or Crematory Feb 11 , 2011 Pine View Crematorium []Entombment Address : . ©Cremation Queensbury, NY Removal Date Place Removed and/or Held and/or Address ,• .3 Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Date Cemete Address 0 Reinterment ry Permit Issued to Registration Number _ Name of Funeral Home Carleton Funeral Home, Inc. Address 0026 11 68 Main St., Hudson Falls, NY 12839 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 rema sdescribed abov indicated. Date Issued a l( c ,_m II Registrar of Vital Statistics .L Q_ ' E _- J (signature) District Number �C Place Obi 7 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition tErs is-i 704 Place of Disposition -tat/kJ L_fe/►r.c f dr,v6.. (address) (section) a _ (lot nu er) (grave number) • Name of Sexton or Person in Charge of emises o.J r r.vi(} (please print) SignatureOffk Title CliEh►►,TOVk-- (over) DOH-1555 (02/2004)