LaCroix, Christopher James (os7
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christopher James LaCroix Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2021 20 Years War or Dates
P Place of Death
Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death Natural Cause ED Accident ❑Homicide ❑Suicide ❑Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Paul Marra Coror
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 3096
ElBurial Date Cemetery,Crematory or Facility Name
12/20/2021 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
❑Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
co ❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/15/2021 Registrar of Vital Statistics rDanielk5cilkupie gkctronical151 Stgne9
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition f ZI2c hi Place of Disposition
2 (address)
W
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises /�rt' •print)
lN'��
(pi se print) n
Z L f� J�/G� f'`
W Signature Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of }"delivered on , 20,
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#