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LaTourrette, Jr. William • NEW YORK STATE DEPARTMENT.OF H- ft L73 Vital Records Section Burial - Transit Permit iiiiig Name First Midd` Last Sex William M. LaTourrette, Jr. Male Date of Death Aritiv eteran of U.S,Armed Forces, Aug. 16, 2018 89 yrs. _lc War or Dates no Place of Death Hospital, Institution or City, Town or Village Fort Ann Street Addres4 Browns Way 1 Manner of Death©Natural Cause El Accident El Homicide ci Suicide ri Undetermined El Pending Circumstances Investigation Medical Certifier Name Title Robert Evfans DO. <> Address II 1 Trongate/�i-1- "%cl ens tto- NY_ 12801 `< � Death Certificate Filed I District Number Registermber ___ City, Town or Village Fort Ann C75�i Date Cemetery or Crematory ❑Burial Aug. 17, 2018 PineView Crematorium Address 0 Cremation Oueensbury, NY. 804 Date Place Removed Z ni Removal and/or Held itt E and/or Address Hold 0 Date Point of N0 Transportation Shipment 5 by Common Destination • Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address <> Permit Issued to Registration Number iiiq Name of Funeral Home Mason Funeral Home 01 1 1 7 j Address 18 George St. , Fort Ann, NY. 12827 III Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remma1'ns described above ems indicated. iliii Date Issued 8/1 6/18 Registrar of Vital Statistics U 4i '`4-' ''- (signa� � District Number 575 4 Place ji{flt----E " 11----1-Lj' 7Z-cz-t_.) c-yi-S j...„- /..? 'i C d 1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iR 6 Date of Disposition $in(( Place of Disposition R.U1 L t — • 2 (address) LU LA CC (section) (lot nu er) (grave number) Name of Sexton or Person in Charge of Premises rattyL. S a A"4t z � i (please print) 1 U: Signature t Title OimAT44.. (over) DOH-1555 (9/98)