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LaMay, Robert 11SbL NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ::.. Name First Middle Last Sex N. Robert P. LaMay Male j:•E Date of Death Age If Veteran of U.S. Armed Forces, July 31, 2015 75 War or Dates 1958-1959 1 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death I X)Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation . Medical Certifier Name Title E Marvin Davidowitz MD 'r' Address r. 100 Park Avenue Glens Falls,NY ' Death Certificate Filed District Number t Regist r Number :::r City, Town or Village �c0 1 0s-1 ❑Burial Date Cemetery or Crematory August 4, 2015 Pine View Crematorium ❑Entombment Address 0 Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed ZZ I I Removal and/or Held and/or Address H Hold p Q Date Point of NI I Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address I I;:; Permit Issued to Registration Number ER Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 ;ti : Address :j: 407 Bay Road,Queensbury, NY 12804 E: :: Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ' Permission is hereby ranted to dispose of the human remains de ribe a ve icated. r:r ©3 !� �� Date Issued �� Registrar of Vital Statistics (signature) District Number S Z.70/ Place6'14.. /7q/`S /1)/ }; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition ' /SirPlace of Disposition Filed-J C'c.'c-- 2 (address) W co 0 (section) kflot number) (grave number) pp Name of Sexton or Person in Charge of Premises t 4 r,1 Z (pleTse print) W Signature C.- Title faZ'Ffh1111C (over) DOH-1555(02/2004)