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LaRocque, Joseph NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit .•. Name First Middle Last Sex :$: Joseph P F. LaRocque Male .. Date of Death Age If Veteran of U.S. Armed Forces, :;.: December 28,2014 87 War or Dates Place of Death Hospital, Institution or Z City, Town or Village Chester Street Address 140 Old River Road ti Manner of Death n Natural Cause J Accident y Homicide n Suicide n Undetermined I Pending Circumstances Investigation Ili Medical Certifier Name Title Dr.Paul Bachman MD :°'°' Address HHIIN,Warrensbu g,NY 12885 Death Certificate Filed District Number Register Number _ . City, Town or Village T/O Chester 6-&5"2- 17 ❑Burial Date Cemetery or Crematory ❑Entombment December 30,2014 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed ZO n Removal and/or Held and/or Address F_" Hold N 0 Date Point of N n Transportation Shipment a by Common Destination Carrier pi Disinterment Date Cemetery Address n Renterment Date Cemetery Address Permit Issued to Registration Number r.• °. Name of Funeral Home Alexander-Baker Funeral Home 00037 f Address ;;: 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom e Remains are Shipped, If Other than Above Address Permission is her by gr nted to dispose of the human re ai s des ibe a o as in icated.. :4 t 1 Date Issued % Registrar of Vital Statistics (signatu e) District Number 610 2.... Place T/O Chester,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition tt 131/tu Place of Disposition Z L C- ' _ W (address) N C (section) (lot number) r-, (grave number) QName of Sexton or Person in Charge of Premises r, ice. 314,04(4 Ze (please print) LLf Signature Title Cr,,. t (over) DOH-1555 (02/2004)