LaPointe, Muriel NEW YORK STATE DEPARTMENT OF HEALTH �� 3)D
Vital Records Section Burial - ransit Permit
Name First Middle Last Sex
Muriel R. LaPointe Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 14,2016 91 War or Dates
,1,. Place of Death Hospital, Institution or
Z° City, Town or Village Glens Falls Street Address Glens Falls Hospital
Ait
to Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Ui Circumstances Investigation
Medical Certifier Name Title
James North
Address
100 Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Reg( ." Number
City, Town or Village Glens Falls 5601 Q�Di
❑Burial Date Cemetery or Crematory
May 17,2016 Pine View Crematory
El Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
yTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
II Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
, Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I. Remains are Shipped, If Other than Above
a Address
ILI
Permission is hereb granted to dispose of the human(remains .escribed above as in,icate .
Date Issued �jrj li`i JCAO Registrar of Vital Stati tics \\ AK/ f
` (signature)
District Number 6�PD I Place / L
I certify that the remains of the decedent identified above were disposed of in accordance ith this permit on:
W Date of Disposition 5Jj'//b Place of Disposition -e)J.j
2
W (address)
U)
Ce (section) r . - (lot n Jumber) (grave number)
O
p Name of Sexton or Person in Charge of Premises s ',`'��,/J
Z h i (please print)
al Signature (iC c, Title (f1 'vJ715K.
(over)
DOH-1555 (02/2004)