LaBarge, Patricia NEW YORK STATE DEPARTMENT OF HEALTH
,. g S 75
Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
• Patricia Joan LaBarge Female
• Date of Death Age If Veteran of U.S. Armed Forces,
;` 07/15/2018 81 Years _ War or Dates
Vii Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Fans Hospital
Manner of Death j Natural Cause D Accident Q Homicide 0 Suicide Q Undetermined Pending
Circumstances Investigation
lL t Medical Certifier Name Title
Michael Miles MD
cia Address
-, 100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
i C' City, Town or Village Glens Falls 5601 346
4,1
( Burial Date Cemetery or Crematory
07116t2018 Pine View Crematorium
'QEntombment Address
,,raiLgemation Queensbury Town, New York
Date Place Removed
g Removal and/or Held
and/or Address
• Hold
Date Point of
0 Transportation Shipment
C by Common Destination
Carrier
Dii
Date Cemetery Address
snterment
❑Reinterment 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
i, , Remains are Shipped, If Other than Above
Address
IZ
ILI
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/16/2018 Registrar of Vital Statistics Robert Curtis rEt'ctronica y Aped)
(signature)
District Number 5601 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 1111 t(f Place of Disposition ��t1 lt,,,7tw
(address)
(section) (1 umber) (grave number)
ram' Name of Sexton or Person in Charge of P emises S
(please rint) �n'i,n
W Signature � � Title t raw �}�l-
(over)
DOH-1555(02/2004)