LaFond, Linda Rae . ilLUF # 713
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda Rae LaFond Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/2912022 67 Years Waror Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 118 Adirondack Street,Queensbury Town,New York 12804
Manner of Death �Natural Cause EjAccident Homicide �5uicide Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
al Christopher Hoy MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
Cit ,Town or Villa 5657 141
Burial Date Cemetery,Crematory or Facility Name
09/30)2022 Pine View Crematory
Entombment Address
UCremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
NTransportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
ElReinterment
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
I— 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 09/30/2022 Registrar of Vital Statistics Carotins.7flaegarrler&rrher' 4ctrontiv 'Srgnsd}
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on;
Date of Disposition jO! 1 7Z Place of Disposition .4 rt. JL l'(Or.
W
2 (address)
Lu
N CC (section) , (lot number) (gram number)
8 Name of Sexton or Person in Charge of Premises '; El
z ( lease print)
uJ Signature Title ��'�/a� /�Q
DOH-1555(07/18)p 1 of 2
4� r 1
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#