Barrant, Larry NEW YORK STATE DEPARTMENT OF HEALTH t
Vital Records Section Burial - Transit 14irmit
Name First Middle Last Sex
Larry Barrant Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 21, 2013 72 War or Dates
1-± Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending
U Circumstances Investigation
Medical Certifier Name Title
ri Andrij Barand, M.D
Address
6 Care Lane Saratoga Springs, NY 12866
Death Certificate SPRINGS File District NumberNumber
3-City, Town or Village�ARA ���; "4 pRegister ®
0 Burial Date Cemetery or Crematory
January 24, 2013 Pine View Crematorium
❑Entombment Address
'.®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
E Hold
CO Date Point of
a ❑Transportation Shipment
GO by Common Destination
t Carrier
Date Cemetery Address
❑ Disinterment
1 [II Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
,_- Name of Funeral Firm Making Disposition or to Whom
N Remains are Shipped, If Other than Above
2 Address
re
lii
11.,. Permission is h reby ranted to dispose of the human remains n d ove'�i ' ated.
Date Issued 1 "2. -Z { egistrar of Vital Statistics i -
SARATOGA SPRINGS (signature)
District Number U (Di Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition i'- ZS M a Place of Disposition tc Ota,,,t) a t 10-
X (address)
W
(00
[I (section) I (lot number) r (grave number)
pName of Sexton or Persçjhar , emises f6 i'S d
W
(please print)
Signature Title COOrtQL
(over)
DOH-1555 (02/2004)