Lafreniere, Irving E C w V—
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Irving E Lafreniere Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/25/2022 64 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Lake George Town Street Address 42 Sewell Street 10, Lake George Town,New York 12845
Manner of Death Natural Cause n Accident C Homicide Suicide n undetermined n Pending
W C.) Circumstances Investigation
Wp Medical Certifier Name Title
Charles Yun MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Lake George 5651 5
Burial Date Cemetery,Crematory or Facility Name
02/28/2022 Pineview Crematorium
El Entombment Address
l^1 Cremation Queensbury Town, New York
11 Donation
p —_ Removal Date Place Removed
— and/or and/or Held
Hold Address
0
(1) ❑Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
C Reinterment
Permit Issued to Registration Number
Name of Funeral Home Radloff Funeral Home Inc 01425
Address
136 Warren St,Glens Falls,New York 12801
Name of Funeral Firm Making Disposition or to Whom
f-- Remains are Shipped,If Other than Above
Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/28/2022 Registrar of Vital Statistics I'atr7crr R.%11-Vine_y-,S?iu.r/ergkcirornca76,,50/e9
(signature)
District Number 5651 Place Lake George, 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 2 1Z$iZZ Place of Disposition r ��
(address)
W
(section) //� (lot number) (grape number)
0 Name of Sexton or Person in Charge of Prises 'A1 5 � ul
Z (pte se print) � �
W Signature Title "IOC
DOH-1555(07/18)p t of 2
r �' (r
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#