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LaFay, Josephine NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex , Josejot A. LaFay Female Date of Death Age If Veteran of U.S. Armed Forces, April 26, 1997 78 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title David Foote Md Address Rt 4, Hudson Falls, N.Y. 12839 Death Certificate Filed District Number Register Number "" Glens Falls'. city, n S�o/ -� c� D Date Cemetery cir Cr ator ❑Burial April 28, 1997 Pine iewrematoritnn Address Cremation Tn of Queensbury, NY 12804 Date Place Removed Z Removal and/or Held P and/or Address Hold 0 Date Point of ❑Transportation Shipment 5 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address <> Permit Issued to RegistrW60umber Name of Funeral Home Carleton Funeral Home Inc. Address P.O. Box 67, 68 Main St., Hudson Falls, N.Y. 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby ranted to dispose of the human remains descri/bedbov/e�as ins/gatye�. Date Issued `/ Z8 Registrar of Vital Statistics Xe� / /�( L/oi \ (signature) Place Glens Falls, NY 12801 District Number 5 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W. Date of Disposition �`i,- Place of Disposition / i��[�/ ��/ �/C�/�/ (�<y 1 (address) UJI N >� (sectio"n)� (lo numberl I (grave number) GName of Sext or Person in Charge of Premises g (please print - Signature -�a-=. Titles / 1FAII 701 � l DOH-1555 (10/89) p. 1 of 2 VS-61