LaFreniere Jr., Bryan v / WWI
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bryan LaFreniere Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 03 / 2017 30 War or Dates N/A
Place of Death Hospital, Institution or
City, Town or Village Galway Street Address 5867 Sacandaga Road
aManner of Deathi2s177 Natural Cause El Accident n Homicide 0 Suicide 7 Undetermined 0 Pending
i Circumstances Investigation
tu Medical Certifier Name Title
0 Daniel J. Kuhn Coroner
Address
40 McMaster St., Ballston Spa. , NY 12820
Death Certificate Filed District Number Register Number
City, Town or Village Galway
(Burial Date Cemetery or Crematory
02 / 08 / 2017 Pine View Crematory
`'' riEntombment Address
ECremation Queensbury, NY
Date Place Removed
4❑Removal and/or Held
and/or Address
Hold
Up
Date Point of
i Transportation Shipment
Et by Common Destination
iN Carrier
` ; Disinterment Date Cemetery Address
Date Cemetery Address
a 0 Renterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
ili 402 Maple Ave., Saratoga Sp., NY 12866
in Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
it
ill
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 21'7/ if) Registrar of Vital Statistics ��„- /in c`�`
(signature)
District Number 9,5 S ep Place Galway , New York
iipi
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on;
SU Date of Disposition 2190 Place of Disposition gpt,V,1,-J Gwmafot 1+�
2 (address)
# L
01
CE (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge Premises tiir,s �t"^th"
R (pl se print) .
Signature
4 � h? Title (i 'A -
(over)
DOH-1555 (02/2004)