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LaGurege, Deshawn M if (36 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records w Name First Middle Last Sex =l Deshawn M.LaGurege Female Date of Death Age If Veteran of U.S.Armed Force, 12/13/2020 86 Years War or Dates _ _ Place of Death Hospitak.[eillillifaror :L City,Town or Village Lake George Village Street Addreer; 70 West Street Lake-George Village, New York 12845 pManner of Death ©Natural Cause ❑Acciit4qt Homicide 0 Suicide DUI-determined 0 Pending Ltl Circumstances Investigation W Medical Certifier Name Title- Paul Bachman MD it Address 3767 Main Street,Warrensburg Town,New York 12885 Death Certificate Filed District Number Register Number ��� City,Town or Village Lake George Village 5620 8 r` �Burial Date Cemetery,Crematory or Facility Name , .,, 12/16/2020 Pine View Crematory Entombment 1 Address Cremation Queensbury Town,New York Donation 4 0 Removal Date Place Removed and/or and/or Held NHold Address -Ai Date Point of !) U Transportation Shipment Q by Common , Carrier Destination '_ Date Cemetery Address z Disinterment ❑Reinterment Date Cemetery Address i3;, Permit Issued to Registration Number A'xt• Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 rr Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address CC W 41:- Permission is hereby granted to dispose of the human remains described above as indicated. '`rr' Date Issued 12/15/2020 Registrar of Vital Statistics Debra I9Kckinney(ECectronicaltySigned) (signature) District Number 5620 Place Lake George Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: -!r WZDate of Disposition i2,1la flu Place of Disposition ,, J 1.—. efio^-- 2 (address) ILI NCC (section) A(lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre is s , �'' �"'' u�>~�cdt Z (please print)U Signature (API Title itr 04. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) -4111 u 14 2 9 9 i Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#