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Ball, Larry Sterling NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Larry Sterling Ball Male Date of Death Age If Veteran of U.S.Armed Forces, 05/22/2021 72 Years War or Dates 1967-1975 Place of Death Hospital,Institution or WCity,Town or Village Moreau Town Street Address 535 Selfridge Road,Moreau Town,New York 12831 Manner of Death © Natural Cause ❑Accident Homicide ❑Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Danielle Moriarity NP Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 26 ElBurial Date Cemetery,Crematory or Facility Name 05/24/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York Donation Removal Date Place Removed Q and/or and/or Held H N Hold Address 0 Date Point of ❑Cl) Transportation Shipment by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/24/2021 Registrar of Vital Statistics Geeann Mc cabe(ECectronicaffy Signed) (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:pp Z Date of Disposition S- z,Z1 Place of Disposition P, e.v W (address)// W CC (section) (lot number) (grave number) Name of Sexton or Pers Cha Premises 1 r ✓r 6�`4"e— `�' Q (please print) Z W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014 310 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#