LaPelle, George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last �le
ex
George A. LaPelle
Date of Death Age If Veteran of U.S. Armed Forces,
8/16/99 78 War or Dates Yes. WWII
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death�Natural Cause Accident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Paul R.Philion MD
Address
3 Irongate Center Glens FAl1s,NY 12$01
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 r�
Date Cemetery or Crematory
El Burial 8/18/99 Pine View Crematorium
Address
Cremation Queensbury,NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Q Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to tratioSullivan - Minahan & Potter Re8824 n Number
Name of Funeral Home
Address
407 Bay Rd. Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
_Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains des ibe`d a-bb ind' e .
Date Issued 8/18/99 Registrar of Vital Statistics ���Gr� G
(signature)
District Number 5601 Place Glens FAlls NY
I certify that the remains of the decedent identified above were disposseed�of in/accordance
>with this permit on:
g
� (address)Date of Disposition l �9 Place of Disposition /�� �/ "V C/` /yl� 917/z
+W
cc (s ction)" (lot number) ' I(grave number)
Name of Sexton or Perso in Charge of Premises _
E please pant) �' � f
Signature TitleLXI
G /v
(over)
DOH-1555 (9/98)