Loading...
LaMay, Terry NEW YORK STATE DEPARTMENT OF HEALTH k lc0 Vital Records Section Burial - Transit Permit Name First Mid1le• Irl Last Sex Terry Wayne ' ' LaMay Male Date of Death Age If Veteran of U.S. Armed Forces, December 5, 2015 66 War or Dates Vietnam i0- - of Death Hospital, Institution or W own or Village Glens Falls Street Address Glens Falls Hospital Wanner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending 0 Circumstances Investigation W Medical Certifier Name ' Title W Michael Fuller, M.D Address 48 East Street Fort Edward, NY 12828 itattl Certificate Filed District Number Reg' r Number City2rown or Village Cole n 5 i�-i- 5601 DI7 ❑Burial Date Cemetery or Crematory December 7, 2015 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z Removal❑ and/or Held and/or Address p Hold O Date Point of a. ❑Transportation Shipment co by Common Destination CI Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address El Reinterment 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 2 Address W 0_ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued /2 I,115 Registrar of Vital Statistics W 4.1,,,g LAJ 4 (signature) District Number 5601 Place 6(S2MS vG k.1 5 / . y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 12/07/2015 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W CO re [(section) g (lot number) (grave number) in• Name of Sexton or Person in Charge of Premises nr>> L..number,..) z oplease print) W Signature / iJ Title a 'Pil (over) DOH-1555 (02/2004)