LaBar, Frank NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frank M.LaBar - Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/16/2018 84 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Courtney Stewart NP
W.
im Address
ksA 100 Park St,Glens Falls,New York 12801
tzi
XI Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 301
❑Burial Date Cemetery or Crematory
06/18/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation t Shipment
by Common Destination
Carrier
ftr.I]Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
7-7 Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/18/2018 Registrar of Vital Statistics Men A Curtis(f(ectronicaffy Signed)
(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 if(!ilif Place of Disposition &U ✓ �rlerr'td,-4--
(address)
(section) Alot number) (grave number)
Name of Sexton or Person in Charge of Premises (A'N J�^tt
i° (pi se print)
Signature Zi � Title t`Zint10,
(over)
DOH-1555 (02/2004)