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Labarge, Ralph Odin 473 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ralph Odin Labarge Male Date of Death Age If Veteran of U.S.Armed Forces, 01/19/2022 56 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending LLJCircumstances Investigation W Medical Certifier Name Title CI William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 47 ❑Burial Date Cemetery,Crematory or Facility Name 01/20/2022 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Q ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of CO ❑Transportation El Common Shipment Carrier Destination Date Cemetery Address El Disinterment ❑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 F. Remains are Shipped,If Other than Above M2 Address Cr W 0" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/20/2022 Registrar of Vital Statistics Megan Wolin(ECectronicaCCySigned) (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: ~ 1_ p -F� Z Date of Disposition rZZ LpZZ Place of Disposition ,�� v� Cr-.Gy1dk W ' (addr ss W LO CC (section) (lot number) (grave number) SName of Sexton or Person in Cha of Premiss T iat��G7,, D paw,/ Z / (please print) W Signature ! f Title 0 DOH-1555(07/18)p t of 2 r; i Public Health Law Sec. 4145(2b) `� ' Receipt Human remains of delivered on , 20d' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#