LaPrairie, William NEW YORK STATE DEPARTMENT OF HEALTH'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William G. LaPrairie Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 14,2015 74 War or Dates 1959- 1965
f, Place of Death Hospital, Institution or
Z. City, Town or Village Thurman Street Address
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
tU Circumstances Investigation
uii` Medical Certifier Name Title
O Paul Bachman
Address
3767 Main Street,HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Thurman 5659 5
❑Burial Date Cemetery or Crematory
June 17,2015 Pine View Crematory
El Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
t.' Hold
Cl)
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n 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
!! Remains are Shipped, If Other than Above
2 Address
CC
W
O Permission is hereby granted to dispose of the human re ins described above as ' 'cate .
Date Issued /6, ap/s Registrar of Vital Statistics ,
(signature)
District Number 5659 Place Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition (a I ig ii5- Place of Disposition ,mb.,..J e�-vio,
W (address)
Cl)
Ce (section) t (lot num er) (grave number)
QName of Sexton or Person in Charge of Premises A- rip
Z (please print)
W Signature 1C. Title 1j26,6" (
(over)
DOH-1555 (02/2004)