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LaValley, Louis Noel NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Louis Noel LaValley Male Date of Death Age If Veteran of U.S.Armed Forces, 08/17/2021 68 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WW Manner of Death ©Natural Cause El Accident EIHomicide El Suicide El Undetermined El Pending V Circumstances Investigation QW Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 344 ❑Burial Date Cemetery,Crematory or Facility Name 08/25/2021 Pine View Crematorium ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation 6 El Removal Date Place Removed and/or and/or Held Hold Address N 0 n- 1-1 Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5. Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/19/2021 Registrar of Vital Statistics 14)6ertAndrew Curtis(E(ectronical(y Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Date of Disposition -01-7--J—f Place of Disposition (1 v i e,w Ci`(rem5 0c�/ 2 (ad ess) W CC N (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises C (-M P.)' c{,,S Z (pleaseArint) lL Signature ti C/t Title C.r�.✓nc1t ,r DOH-1555(07/18)p 1 of 2 J _ Public Health Law Sec. 4145(2b) Receipt Human remains of ' - delivered on: , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,