LaPlant, Claudia Jean . 2 l
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Claudia Jean LaPlant Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/23/2021 69 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 10 South Road,Moreau Town,New York 12831
111
0 Manner of Death 177,1
Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined ❑Pending
uJ Circumstances Investigation
W Medical Certifier Name Title
CI Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 13
❑Burial Date Cemetery,Crematory or Facility Name
02/25/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
ElDonation
Is ❑Removal Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
�_— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/25/2021 Registrar of Vital Statistics Zeman.Vcca6e(ElectronicafSrgned)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W▪ Date of Disposition '� I?4 Place of Disposition OA.2 ddress)
W
CC CC (section) (tot[umber) (grave number)
0
Name of Sexton or Person in Charge of P mises i1 r
please prig)
W Signature � Title —
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 01451
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#