LaFlamme, Guy 4 '70 j
NEW YORK STATE DEPARTMENT OF HEALTH Burial Records Section Burial - Transit Permit
,,,`' Name First Middle Last Sex
Guy Richard LaFlamme Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/15/2017 89 Years War or Dates 1946-1947
k Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
0, Manner of Death 0 Natural Cause Ei Accident 0 Homicide E Suicide El Undetermined Pending
Circumstances Investigation
tu Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 452
❑Burial Date Cemetery or Crematory
09/19/2017 Pine View Crematorium
❑Entombment Address
,,,®Cremation Queensbury Town, New York
kt
Date Place Removed
Z❑Removal and/or Held
and/or Address
F Hold
aDate Point of
❑Transportation Shipment
G by Common Destination
Carrier
, ElDisinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
n Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
2 Address
ill
,,, Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/18/2017 Registrar of Vital Statistics 2ohnT Tranck !E(ectronicalysigned
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition Place of Disposition fintik...,J Cre", c"."
w 112610 (address)
Cl) (section) Plat pumber) grave number)
Name of Sexton or Person in Charge of Pr mises y ��v LLV1I V
z'' (plea a printt)
W: Signature �r I Title 4� •�� �
9
(over)
DOH-1555 (02/2004)