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LaHart, Joan NEW YORK STATE DEPARTMENT OF HEALTH 1 L1 10 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joan Marie LaHart Female Date of Death Age If Veteran of U.S. Armed Forces, July 20,2013 86 War or Dates Place of Death Hospital, Institution or Z City, Town or Village Lake Placid Street Address 10 Dooling Way#4 • Manner of Death n Natural Cause n Accident n Homicide I 1 Suicide Undetermined Pending Circumstances Investigation u Medical Certifier Name Title G Brian Guadagno Address 2249 State Rt.86,Saranac Lake,NY 12983 Death Certificate Filed District Number Register Number City,Town or Village Village of Lake Placid 1523 ❑Burial Date Cemetery or Crematory Entombment July Pine View Crematory Address 2013 ©Cremation 21 Quaker Rd.,Queensbury,NY 12804 Date Place Removed ZZ r'Removal and/or Held and/or Address H Hold to O Date Point of y n Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address I Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Clark,Inc. 01075 Address 2310 Saranac Ave.,Lake Placid,NY 12946 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped, If Other than Above 2 Address UJ a. Permission is hereby granted to dispose of the human r 'ns d cribed above as indicated. Date Issued 07-22-2013 Registrar of Vital Statisti s (signature) District Number 1523 Place Village of Lake Placid I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: n Date of Disposition 7.j3'(-3 Place of Disposition ga-UA-) C r44.4))tiv.. (address) N (section) (lot mber) S (grave number) pName of Sexton or Person ' Charge of Pre ises ( lease pri t) Signature Title �1Zft(OC, (over) DOH-1555(02/2004)