LaTulippe, John James ii&I 41 9 I I
NEW YORKSTATE DEPARTMENT OF HEALTH Burial- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John James LaTuippe Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/15/2022 64 Years War or Dates 1975-1960
h,,, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 31 McDonald Street D,Glens Falls,New York 12801
8 Mannerof Death a Natural Cause DAcddent 0 Homicide Duicide Undetermined ❑Pending
Ili Circumstances Investigation
W Medical Certifier Name Title
C John Lukaszewlcz MD
Address
101 Ridge Street 2,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Villa 5601 268
Burial Date Cemetery,Crematory or Facility Name
Address
Cremation Queensbury Town,New York
DDonation
Removal Date Place Removed
and/or and/or Held
F
— Hold Address
Transportation Date Point of
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
EiReinterment
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
1— Remains are Shipped,If Otherthan Above
S Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/17/2022 Registrar of Vital Statistics -*van Aroner.Gchv I( 'J'gnmd)
(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:
Date of Disposition 5-11 141 I it. Place of Disposition ,,,,iL. arr---:----
ILI
(add ess/
W
Ir (section) (lot number) / (grerc number)
8 Name of Sexton or Person in Charge of Pre s L� s L�
Z (Flews Pried
III Title IPf-m 4t rtlir
Signature
DOH 1555(o7/18)p t of 2
f r1 7
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#