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LaBarge, Frank A
NEW YORKSTATE DEPARTMENT OF HEALTH (ii ) Burial - Transit Permit - -Pt /0J:), I Bureau of Vital Records Name First Middle Last Sex Frank A.LaBarge Male Date of Death Age If Veteran of U.S.Armed Forces, 01/26/2024 70 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 12 Frankie Lane,Moreau Town,New York 12828 IJJ p Manner of Death Ill Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Autumn Webb PA Address 102 Park Street,Glens Falls,New York 12801 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 8 ElBurial Date Cemetery,Crematory or Facility Name 01/29/2024 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation 0Z❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 n. Date Point of V)0Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above N Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/29/2024 Registrar of Vital Statistics Brenda?futter(ECectronica((ySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition 1130 iZy Place of Disposition r-rw6vcF..../ Cefollwe 2 (address) W NII (section) (tot number) (grave number) 0 Name of Sexton or Person in Charge of Premises is �'— �/�1 Z J (plse print) / lL Signature Z.. ,__.....-1/4--- Title ! '�� .) DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) L` Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#