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Lapoint, Edward ._..,- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit PermitVital Records Section Name First Middle Last Sex }: Edward George Lapont Mate Date of Death Age If Veteran of U.S. Armed Forces, r 12108/2018 84 Years War or Dates 1954-1957 Place of Death Hospital, Institution or City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc l Manner of Death Natural Cause ❑Accident 0 Homicide El Suicide ❑Undetermined ri❑Pending Circumstances Investigation tki Medical Certifier Name Title Thomas Kandora MO Address 319 Broadway,Fort Edward Town,New York 12828 iv Death Certificate Filed District Number Register Number 449, City,Town or Village Fort Edward 5755 74 '❑Burial Date Cemetery or Crematory 12/11/2018 Pine View Crematorium [Entombment Address t ®Cremation Queensbury Town, New York Date Place Removed ©Removal and/or Held VP and/or Address ig Hold Cli Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom W Remains are Shipped, If Other than Above 3 Address LA ri . Permission is hereby granted to dispose of the human remains described above as Indicated. ill Date Issued 12/11/2018 Registrar of Vital Statistics Aimee;tahoney(ETctron catrySigned (signature) ',k District Number Place 5755 Fort Edward, New York )01 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i Date of Disposition p.,- I -V Place of Disposition ?IVIR) y>(jW (144110ray 2 (address) al th re (section) (lot number) (grave number) Ci et Name of Sexton or Person i Charge of Premises „f/may S V;! s z (please print) W Signature Title (,f Acci•c r (over) DOH-1555(02/2004)