LaCarte, John NEW YORK STATE DEPARTMENT OF HEALTH r Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John Orin LaCarte Male
Date of Death Age If Veteran of U.S. Armed Forces,
October • 2018 82 War or Dates
Place of Deat. Hospital, Institution or
W City, Town or�'llag= Hudson Falls Street Address 50 East LaBarge Street
W Manner of Deat' -a Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 0 Undetermined ri 1--I Pending
W CircumstancesInvestigation
W Medical Certifier Name Title
0 Charles Yun, MD
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village S 7 dt 6 02. 6
, ❑Burial Date Cemetery or Crematory
October 23, 2018 Pine View Crematorium
❑Entombment Address
g�= I Cremation Quaker Road Queensbury,NY 12804
Date Place Pefmoved
z ❑ Removal an, --9Id
O and/or --
Address
Hold St. Paul's Cemetery
(00 Date Point of
0. ❑Transportation Shipment
07 by Common Destination
Carrier
v El Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
:-4 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
I_'= Remains are Shipped, If Other than Above
2 Address
CX
WCL 1
Permission is hereby granted to dispose of the human remains described above
.aslindicated.
Date Issued /0 /)3/4Registrar of Vital Statistics erf /, Q G '6,-r-
(signature)
District Number S" 7 )to Place If ; //G,.e et IL Js yr 1A //S
1- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�
w Date of Disposition 10/23/2018 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
Wco
r, (section) / (lot number) (grave number)
O Name of Sexton or Person in Charge of Premiss L 4 vsvHtf St.'Ott
(ple'ase print)
W Signature 'T" Title ( mnR�
(over)
DOH-1555 (02/2004)