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LaBarron, Irvin Carl if 713 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Irvin Carl LeBarron Male Date of Death Age If Veteran of U.S.Armed Forces, 09/08/2021 78 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Greenwich Town Street Address 47 N Greenwich Road,Greenwich Town, New York 12809 LLJ p Manner of Death © Natural Cause ❑Accident ❑Homicide E Suicide ❑Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title 0 Nicoleta Daraban MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Greenwich 5757 20 0 Burial Date Cemetery,Crematory or Facility Name 09/13/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of N ❑Transportation Shipment Q by Common Carrier Destination El Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above g• Address CC LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/13/2021 Registrar of Vital Statistics Kimberly Whelan(Electronically Signed) (signature) District Number 5757 Place Greenwich, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F Z Date of Disposition 9113114 Place of Disposition 1 n.0 T jv IOtOfv+— W (address) W CO cc (section) (lot number) 504.1 (grave number) 4 0if a Name of Sexton or Person in Charge of Premises �` t(' (pie a print) W Signature i Title 6 " DOH-1555(07/18)p 1 of 2 71 I C; i q Public Health Law Sec. 4145(2b) Receipt A Human remains of - — 17-: delivered on , 20 (- t ,` „i--, Pine View Cemetery Representing the funeral home name4 ap)urIpt;Apermit Official Funeral Directors Reg.or License# I T...)