LaFlure, Joseph .. i (i/CN .ti tiql
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph E. LaFlure Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 20,2013 93 War or Dates World War II
N- Place of Death Hospital, Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Q Natural Cause Accident 0 Homicide Suicide El Undetermined Pending
W' Circumstances Investigation
W Medical Certifier Name Title.
C Suzanne M.Rayeski
Address
100 Park St,Glens Falls,NY 12801
Death Certificate Filed Glens Falls District Numbe5601 Register Number
City,Town or Village 3 7
❑Burial Date Cemetery or Crematory
August 22,2013 Pine View Crematorium
El Entombment Address
®Cremation Quaker Road,Queensbury,NY 12804 _
Date Place Removed
ZZ El Removal and/or Held
and/or Address
E Hold
N
0 Date Point of
ND Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
a Address
WI
a. Permission is hereby granted to dispose of the human remains des ' I boy as i i a d.
Date Issued t F Z./AO/3 Registrar of Vital Statistics ��_/
` (signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance wA
th this permit on:
ui Date of Disposition 2 fv / Place of Disposition ��j� �� p
2
W (address)
Cl)
re
(section) 4 mbe�) (grave number)
p Name of Sexton or erso tin Cha .'�• -remises /�� a/
Z gr/i ) (p/e� ale W►nt) {..
Signature ;� f Title ,�
(over)
DOH-1555(02/2004)