LaBounty, Sherman , 1§ # DI
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit permit
Name First Middle Last Sex
"'. Sherman T. LaBounty Male
Date of Death Age If Veteran of U.S. Armed Forces,
: : March 6,2017 83 War or Dates Korean
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident n Homicide n Suicide Undetermined Pending
It.t Circumstances Investigation
TO: Medical Certifier Name Title
la Cleaver MD
: : Address
HHHN
x Death Certificate Filed District Number Registe ,Number
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
❑Entombment March 7,2017 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
co -
0 Date Point of
c, Transportation Shipment
5 by Common Destination
Carrier
n Disinterment Date Cemetery Address
f Reinterment Date Cemetery Address
51 Permit Issued to Registration Number
a: Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
:6.9 3809 Main Street,Warrensburg,NY 12885
'c¢3 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
. Address
la
Permission is hereby granted to dispose of the human remains described above as indicated.
.:Y), Date Issued 03-07-2017 Registrar of Vital Statistics CIQ,
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r:E; (signet re)
:;,M District Numbers 60 ( Place City of Glens Falls,NY
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z j
w Date of Disposition 3`V /7 Place of Disposition P, Li, C/�>—,4'r'
z / / (address)
w
co
p0 (section) _ _.(lot number) (grave number)
Name of Sexton or er , 'in Charge of Premises t c ,rA✓v /L7-U,, ,-vce,
Z (please print)
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Signature Title C./cc/y/w�p/
(over)
DOH-1555 (02/2004)