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LaTulippe, Raymond NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Raymond J. LaTulippe Male Date of Death Age If Veteran of U.S. Armed Forces, November 7,2012 81 War or Dates Place of Death (� Hospital, Institution or Z City, Town or Village`24e-vmS -4-cA\S n Street Address Glens Falls Hospital p Manner of Death I XI Natural Cause piAcciddrft I I Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Darci Giotti-Grubbs,MD Address Glens Falls,NY Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY 5601 i570 ❑Burial Date Cemetery or Crematory ❑Entombment November 8, 2012 Pine View Crematorium Address ©Cremation 21 Quaker Road,Queensbury,NY 12804 Date Place Removed Z Removal and/or Held O and/or Address H Hold 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 2 Address IX t!t O. Permission is hereby granted to dispose of the human remains descri eed a ove s in ' Date Issued ///Q/2o/Y Registrar of Vital Statistics iG✓ signature) { District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LIJ Date of Disposition //4r/1. Place of Disposition P It,1L't tL W (address��) / U) CL (section) (lot number) (grave number) Z Name of Sexton o Person in Ch rge of Premises 5c 4 .j )•�ra„✓`2, W (please print)A Signature d Title r't �ey, /75S, (over) DOH-1555(02/2004)