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Laferriere, Ray Joseph 4t TB NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ray Joseph Laferriere Male Date of Death Age If Veteran of U.S.Armed Forces, 10/30/2021 76 Years War or Dates unknown E,,. Place of Death Hospital,Institution or WCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Manner of Death © Natural Cause El Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending W C.) Circumstances Investigation W Medical Certifier Name Title 0 Brandii Baker NP Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 66 ElBurial Date Cemetery,Crematory or Facility Name 11/01/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation Z El Removal Date Place Removed 0 and/or and/or Held ~ Hold Address N 0 a. Date Point of U) Li Transportation Shipment C by Common Carrier Destination 0 Disinterment Date Cemetery Address 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 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2021 Registrar of Vital Statistics ShelfeyMckernon(EfectronicaflySigned) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- WDate of Disposition II /Z.171 Place of Disposition r%dJ cry 2 (address) W CO (section) 4 (lot number) (grave number) 0 Name of Sexton or Person in Cha a of Premises t` L_ Ss.%4l fr (phase print) ILJ zv Signature Title CO404 eh( DOH-1555(07/18)p 1 of 2 Tii5278 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#