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LaPoint, Brian NEW YORK STATE DEPARTMENT OF HEALTH 16 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Brian Wayne 14-- LePoint Male Date of Death Age If Vetegiof U.S. Armed Forces, July 7, 2016 62 Warirbates Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address 7 Sherman Ave, Apt 2 LW Manner of Death .i Natural Cause Accident 0 Homicide Suicide Undetermined ❑ Pending U Circumstances Investigation .11 W Medical Certifier Name Title CI' Paul Bachman, M.D. Address 3767 Main Street Warrensburg, NY 12885 Death Certificate Filed District Number / Register uer City, Town or Village J O 0 Burial Date Cemetery or Crematory July 12, 2016 Pine View Crematorium Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address E Hold St. Mary's Cemetery CO Date Point of eL0 Transportation Shipment CO by Common Destination CI Carrier IIIDisinterment Date Cemetery Address I Date — Cemetery Address °»� Reinter— - ___ _,_ Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above M' Address CC W: L- Permission is hereb granted to dispose of the humanQemains d cribed a ove as indicat d. Date Issued , Registrar of Vital Statistics a'.,--�\_\ )2 (signature) District Number i Place .___Zeilf,w k-- '-)i i I certify that the remains of the decedent identified above were disposed of in accorda ce with this permit on: F w'° Date of Disposition 07/12/2016 Place of Disposition Quaker Road Queensbury, Y 12804 2 (address) CO et (section) /y (lot number (grave number) d Name of Sexton or Person in C!.areof Premises G�,,j 3Wasepe ) Signature CrimeTitle 414 ligil- (over)r) DOH-1555 (02/2004)