LaFlure, Judith e . 1 4 1,65
NEW YORK STATE DEPARTMENT OF HEALTH --
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Judith LaFlure Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 1, 2017 64 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Thurman Street Address 869 High Street
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide n Undetermined n Pending
iUtat Circumstances Investigation
ilk Medical Certifier Name Title
Address
Death Certificate Filed District Number Register Number
City, Town or Village Thurman
❑Burial Date Cemetery or Crematory
September 5, 2017 Pine View Crematorium
CI Entombment Address
®Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
F" Hold
Cl)
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
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 remai scribe abQ,- :s indicated.
Date Issued =—/7 Registrar of Vital Statistics /s /t
( ;- ature
District Number ee Place `�/<,C12,,, cfi J / t/ / 8/ O
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
� Date of Disposition 7 / Place of Disposition ij?(Lv,
W (addres )Cl)
0 (section) lot number (grave number)
Op Name of Sexto r Pers in Charge of Premises 1,44 1 Cc,i( U(4-0/ .[
Z (please print)
ua Signature Title / /L/J2 ,,
(over)
DOH-1555(02/2004)