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LaMore, Gary / NEW YORK STATE DEPARTMENT OF HEALTH N l it Vital Records Section Burial - Transit Permit Name First Middle Last Sex Gary L. LaMore Male Date of Death Age If Veteran of U.S.Armed Forces, 1,, March 17, 2013 62 War or Dates 2 Place of Death Hospital, Institution or W City,Town,or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ©Natural Cause 0 Accident E Homicide Suicide E Undetermined Pending W Circumstances Investigation 0 Medical Certifier Name Title W Eric Pillemer MD Address 102 Park Street Glens Falls New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 15 60 ) 1 ) ❑Burial Date March 22, 2013 Cemetery or Crematory Pine View Crematorium ❑Entombment Address 0 Cremation Quaker Road Queensbury New York 12803 h Date Place Removed 0 0 Removal and/or Held and/or Address I" Hold 11) Date Point of 0 0 Transportation Shipment d by Common Destination Carrier 0 Date Cemetery Address 0 0 Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 I— Name of Funeral Firm Making Disposition or to Whom 2 Remains are Shipped, If Other than Above X W Address C. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 3 1 -2-0/f 3 Registrar of Vital Statistics C,,)civ, n,, y. ) �(signafure) District Number .560( Place Glens Falls,New York I- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 (� t1 �+ W Date of Disposition 1-N-0 Place of Disposition _cR4) Crtw 44to)1. 2 (address) W H 0 0 (section) -(lot number) (grave number) O Name of Sexton or Person in Charge of remises r. S nNiti 2 / (please print) SignaturetU dL Title C1I, Nt�i®k v (over) DOH-1555 (02/2004)