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CERTIFICATION OF VITAL RECORD ': ' ' '''-''--"-- ..,..„,....,A,14,,,'-;,-.' ., , ,
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-, CERTIFICATE OF DEATH
FILE# 2013009272 r-'
FULL NAME OF DECEASED ROBERT LAFERA AGE 60 YRS - SEX MALE
DATE OF DEATH NOVEMBER 11, 2013`
i DATE OF BIRTH JULY 20:, 1953 BIRTHPLACE GLENS FALLS, NEW YORK
MOTHER'S/PARENT'S NAME LAUNA RUTH LAFERA (BICKERS)
i FATHER'S/PARENT'S NAME THOMAS LAFERA
PLACE OF DEATH LEBANON, NEW HAMPSHIRE
DOMESTIC STATUS MARRIED
SPOUSE'S/PARTNER'S NAME PRIOR PEGGY WOODS
TO FIRST MARRIAGE/CIVIL UNION
i SOCIAL SECURITY NUMBER 500-60-7218
RESIDENCE SUNAPEE, NEW HAMPSHIRE
PLACE OF DISPOSITION CT RIVER VALLEY CREMATORY, ENFIELD, NEW HAMPSHIRE
FINAL PLACE OF DISPOSITION PINE VIEW CEMETERY, QUEENSBURY, NEW YORK
DATE OF DISPOSITION NOVEMBER 15, 2013 FILE DATE. NOVEMBER 14, 2013
MANNER OF DEATH NATURALAPPROX INTERVAL:ONSET TO DEATH
CAUSE OF DEATH DAYS
a ACUTE MYOCARDIAL INFARCTION
YEARS
b CORONARY A. DISEASE, ATHEROSCLEROTIC, SEVERE
C
A
OTHER SIGNIFICANT CONDITIONS
DESCRIBE HOW INJURY OCCURRED �'
i DATE/TIME OF INJURY
PLACE OF INJURY
LOC\ATION OF INJURY
NAME AND ADDRESS OF CERTIFIER
WENDY A WELLS LAID, DARTMOUTH—HITCHCOCK MED CTR, LEBANON, NEW HAMPSHIRE 03756
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MARGINAL NOTES
2201090
I HEREBY CF.RTtrY THIS-IS A TRUE CpPY ISSUE?riROM THE OFFICIAL RECORDS ON FILE AT THIS OFFICE AND
""�`��` SHAL E-CEiVED AS EYIDENN E WITH THE Mr EFFECT AS THE ORIGINAL. �1��`
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7� rA��9 ATTE T: t- LOCAL REGISTRAR Steelton M.w° ease Registrar ', ;�--.
� ,• �� 4 r LEBANON '���' �f�/ ��
r Nov Ya._ Tar 0- L}}.eng m'4
j, , / ��% DATE ISSUED: -: '`� STATE/CITY/TOWN OF: t1)(i l' ��`;', r>u i:v,
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,�� a ,, r' �1�' This copy not valid unless prepared-On engraved border displaying seal and signature of Registrar. (?1 �ti ��
r,i a - ksy 1 = It shall be unlawful for anyone to reproduce this certificate other than local or State Registrar vs sPt ,l A ,4
5 y .4 ,+_. ,-, ku, somun� ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE .. bf R
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PERMIT MUST ACCOMPANY REMAINS TO DESTINATION
FORM BT-1,12/2010
STATE OF NEW HAMPSHIRE 1.BURIAL PERMIT NO
BURIAL TRANSIT PERMIT 2.CITY OR TOWN
3.DECEDENT'S NAME(First,Middle,Last) 4.SEX 5.DATE OF DEATH(Month,Day,Year)
ROBERT LAFERA MALE NOVEMBER 11,2013
6.AGE 7.DATE OF BIRTH(Month,Day,Year) 8.CITY,TOWN,OR LOCATION OF DEATH 9.COUNTY OF DEATH
60 Years JULY 20,1953 LEBANON GRAFTON
10.METHOD OF DISPOSITION(1.Burial 2.Temp.Entombment 3.Cremation 4.Donation 5.Mausoleum 6.Other): CODE: 3
11.PLACE OF DISPOSITION(Name of cemetery,crematory or other place) CT RIVER VALLEY CREMATORY
12.LOCATION (City/Town,State) ENFIELD,NH
13.DATE OF DISPOSITION(Refer to 19a) NOVEMBER 15,2013
14.IF ENTOMBED(OR CREMATED)PLACE OF FINAL BURIAL PINE VIEW CEMETERY
15.LOCATION OF FINAL DISPOSITION(City/Town,State) QUEENSBURY,NY
A CERTIFICATE OF DEATH,HAVING BEEN FILED AS REQUIRED BY THE LAWS OF TH3 STATE,PERMISSION IS HEREBY GIVE TO:
16.FUNERAL DIRECTOR MARK M PREBISH 17.N.H.LIC.NUM ONLY 1017
18.NAME AND LOCATION OF FACILITY(City/Town,State) RICKER FUNERAL HOME AND CREMATORY,LEBANON,NH
19.COUNTER SIGNED AGENT(City Board of Heath/Sub-Register if app.) 20.CITY/TOWN 21.DATE ISSUED(Month,Day,Year)
MARK M PREBISH LEBANON NOVEMBER 14,2013
CEMETERY OR STORAGE VAULT AUTHORITY SHALL FILL OUT SPACE BELOW WHEN APPLICABLE
22.IF STORED,BODY WAS PLACED IN(Name of Storage Vault) 23.DATE STORED(Month,Day,Year) 24.CITY/TOWN,STATE
25.SIGNATURE OF SEXTON OR PERSON IN CHARGE OF STORAGE VAULT 26.DATE ISSUED(Month,Day,Year)
CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE BELOW
27.TYPE OF DISPOSITION(Cremated,buried,etc.) 28.DATE OF DISPOSITION 29.NAME AND LOCATION OF CEMETERY OR VAULT
CREMATED (Month,Day,Year) (City/Town,State) CT. RIVER VALLEY
NOVEMBER 15 , 2013 CREMATORY , ENFIELD, NH
30.SECTION 31.GRAVE NO. 3rTOF SEXTON OR P SO, IN ARGE
This permit,after being signed by the Sexton or person in charge(or by the Funeral Director where there is no Se •• must be forwarded within six days to
the clerk of the town in which the disposition takes place.
CERTIFICATE OF CREMATION
CREMATION NUMBER 5449 NOVEMBER 15 , 2013
This is to Certify That The Remains of ROBERT LAFERA
Have This Day Been Cremated At Connecticut River Valley Crematory, Enfield, NH. Subject to
Its Rules, Regulations And All Legal Requirements.
All Permits Required By Law Have Been Filed Prior To Cremation.
This Certificate May Serve As A Burial Permit Where Required(
BY \ ktizt
Connecticut River Valley Crematory, 56 School St., P.O. Box 549, Lebanon, NH 03
(603) 448-1568
LAFera \
NAME Age:Robert LaFera g 60
Lot Owner: Thomas J LaFera
Lot# Mohawk 37 Grave# 3
Case: Urn
Died: 1 1 . 1 1 .2 01 3 Interred: 9.2 9.2 2
Funeral Home:CT RIVER VALLEY CREMATORY (NH)
Cemetery: Pine View
LAFERA
Owner
Thomas J. LaFpra
Address Plot
5 Brookwood Dr. Glens Fa11c, NY 12801 Mohawk
Phone # Lot #
37
Deed # Date
1762 4.28.83
Cost Foundation Y - N
$600.00
Location North-Vacant
South-Vacant
West-Vacant
East-Fish/Jacox
Remarks
Record of Interments
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2 Inn to re.2,6 5 U7-6- 7
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