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Lape, Raymond r it 32c NEW YORK STATE DEPARTM EALTH Vital Records Section Burial - Transit Permit Name First 4711R, iddle Last Sex Raymond Lape Male Date of Death Age If Veteran of U.S. Armed Forces, N- 04/17/2018 25 Years War or Dates Place of Death Hospital, Institution or ini City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide =Q Suicide ri Undetermined El Pending Circumstances Investigation Medical Certifier Name Title 0. William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 197 0 Burial Date Cemetery or Crematory 04/20/2018 Pine View Crematory []Entombment Address ®Cremation 4ueensbury Town, New York Date Place Removed Removal and/or Held iand/or Address ri Hold Date Point of 0 Transportation Shipment Ko by Common Destination Carrier Disinterment Date Cemetery Address pi []Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care Inc 00364 Address 4• 02 Maple Ave,Saratoga Springs,New York 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above A• ddress fro rA Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/19/2018 Registrar of Vital Statistics 2ZpoertA.Curtis(ECectronicaCCySigned) (signature) D• istrict Number 5801 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition gizti lig Place of Disposition .�U-� =ot1/4- (address) rni (section) /f(lot number) c (grave number) VI ci Name of Sexton or Person in Charge of remisesUnit, 51-4 (pl se print) L ,I Signature Atd1 Title f�F-rr IVillifiL (over) DOH-1555 (02/2004)