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LaLonde Sr, Jack NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex Jack Casey Lalonde Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, October 2 1997 63 War or Dates Korean Conflict Place of Death Hospital, Institution or ::......City, T Glens Falls Street Address 44 Montcalm St. ..:,.'.Manner of Death Undetermined Pending ©Natural Causes❑Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation ..Medical Certifier Name Title Vincent D. Koh MD Address 102 Park St, Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, T� Glens Falls S 6 Q c ❑ Date Cemetery or Crematory Burial October 6, 1997 Pine View Crematorium ® Cremation Address Tn of Queensbury, NY 12804 Date Place Removed ❑ Removal and/or held -T! and/or hold Address Date Point of ❑ Transportation by Shipment Common Carrier Destination Date Cemetery Address ❑ Disinterment Date Cemetery Address ElReinterment Permit: issued to Registration Number Name of Funeral Firm Carleton Funeral Home Inc. 00313 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 granted to dispose of the human remains described above as Indic ed. »:Date Issued U 3!Cl-7Registrar of Vital Statistics (Signature) Glens Falls, NY District Number Jr C y Place certify that the remains of the decedent identified above were disposed of in�accordance with this permit on: Date of Dispositio Place of Disposition ( Ct/ (address) (Section) (Lot Number) (Grave Number) Name of Sext or Pers in Charge of Pr mises (Please Print) Signatur Title / DOH-1555 (10/89) p. 1 of 2 VS-61