LaPoint, Pamela D. 1..........(--. . -it 31,g
NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Pamela D.LaPoint Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/20/2022 73 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
EManner of Death El Natural Cause DAccident 0 Homicide ESuicide Undetermined ❑Pending
LU
0 Circumstances Investigation
WMedical Certifier Name Title
0 Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
DeaEth Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 242
Burial Date Cemetery.Crematory or Facility Name
05103/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
Removal Date Place Removed
and/or and/or Held
- Hold Address
IA Transportation
Date Point of
0 by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
DReinterment
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
a Address
Q
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued O5/0212022 Registrar of Vital Statistics Alvan.7Ve rr( Sctron:iallj,Sillsa0
(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 perrniton:
WDate of Disposition 3/3]2Z Place of Disposition ' ?_J 4--
2 (addressT
W
CB (section) (lotl num5oviv4 (grate number)
Q �
gName of Sexton or Person in Charge of Premises f t
Z ease print)
W Signature Title
( 04 Pg-
DOH-1555(07/t8)p 1 of 2
9.a ,
, 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#