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LaRoe, Edward L
# 711 NEWYORKSTATEDEPARTMENTOFHEALTH f Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward L.LaRoe Male Date of Death Age If Veteran of U.S.Armed Forces, 02/27/2024 69 Years War or Dates p... Place of Death Hospital,Institution or z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death Natural Cause Accident El Homicide ESuicide Undetermined riPending Circumstances Investigation 0UJ Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 120 Burial Date Cemetery,Crematory or Facility Name 02/29/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation 0 El Removal Date Place Removed — and/or and/or Held N Hold Address 0 O. Date Point of (f) Transportation by Common Shipment Carrier Destination ODisinterment Date Cemetery Address EIReinterment 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 1— Remains are Shipped,If Other than Above M Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/28/2024 Registrar of Vital Statistics Megan Wolin(E(ectronicaffySigned) (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: I- W Date of Disposition 31J 1\Z 1 Place of Disposition .j if —t tk>v tIt►2v. 2 (address) W (section) (lot number) (grave number) 8 Name of Sexton or Person in Cha of Premises ( tql. H z (pease print) W Signature Title �t >riq�2 DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) ji Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#