LaPierre, William George NEW YORK STATE DEPARTMENT OF HEALTH
LF Burial — Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William George LaPierre Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/26/2022 81 Years War or Dates
i,,,, Hospital,Institution or
Place of Death P
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause Accident ❑Homicide 0Suicide 17Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Kasandra Frasier PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 233
X Burial
Ei Date Cemetery,Crematory or Facility Name
04/30/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury,New York
Donation
g 0 Removal Date Place Removed
and/or and/or Held
I-
- Hold Address
(
0
CI. Date Point of
(n OTransportation Shipment
ei by Common
Carrier Destination
Disinterment Date Cemetery Address
D Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/27/2022 Registrar of Vital Statistics Megan Notn(E(ectronicalTy Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: p,�
W �Y Date of Disposition `a4 Place of Disposition tZ, C�v,o R RD t l t 11t� N� 1,104
(address)
1
w Eaie 85 F 1
cccoon) • (lot number) (grave number)
g Name of Sexton or Per ' — 1G k
(please print)
W Signature _ Title `,V.' t �""
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
012908
Receipt
Human remains of t.2 - delivered on , 20 ,
Pine View Cemetery RePresenting the funeral home named on burial permit
Official Funeral Directors Reg.or License# ,
•
LaPierre 1/LF
NAME William LaPierre Age: 81
Lot Owner: William & Sandra LaPierre
Lot# Erie 83 F Grave# 1
Case: Concrete
Died: 4 .2 6.2 2 Interred: 4.3 0.2 2
Funeral Home: Baker FH
Cemetery: Pine View
LaPierre ( 4!)
Owner
William & Sandra LaPierre
Address Plot
6 Chelsea Place, Queensbury, NY 12804 Erie
Phone # Lot #
518-480-4464 83F
Deed # Date
4267 6/8/2021
Cost Foundation Y - N
$1300.00
Location West-Vacant
East-Vacant
South-Raspante
North-Sankey
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES & REGULATIONS OF THE
PINE VIEW CEMETERY: /
SIGNATURE: _ ��. o ?�Q__ DATE: (j 5' '�
SIGNATURE:AY/ AaZx_., DATE: c2/
Record of Interments NDN L.4. [
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