Turner, Michael E35_
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael Patrick Turner t1
Date of Death Age If Veteran of U.S. Armed Forces,
Dec . 2 , 2006 42 War or Dates LJo
1 . Place of Death Town o` Moreau Hospital, Institution or 12 reservoir R o a a
W City, Town or Village Street AddressFor t Edward , NY 12326
II Manner of Death Natural Cause 0 Accident D Homicide 0 Suicide riUndetermined 0 Pending
W Circumstances Investigation
at Medical Certifier Name Title
Q J. Paston M. D.
Address
211 Church St . Saratoga Springs , NY 21366
Death Certificate Filed Town of Moreau District N mber Register Number
City, Town or Village Number
❑Burial Date 12/5/0 6 Cemetery or Crematory
Pine View Crematory
['Entombment Address
, ;DICremation Queensoury, NY 12804
Date I Place Removed
t ❑Removal and/or Held
and/or Address
t: Hold
0
0 Date Point of
ai 0 Transportation Shipment
G by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to i�strra�tion Number
Name of Funeral Home M.B. Kilmer Funeral Homed .�
Address
136 Main St . South Glens Falls , NY 12003
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tr
LUJ
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued / 5-0(p Registrar of Vital Statistics CIO
(signature)
District Number q (DZ Place b 1 UDSoN 01- �UC17/-/ 6LCN-S 7-41k3 AiV /.2803
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
t Date of Disposition 12/1/ Cc, Place of Disposition T 'prvu.l Crovsctivf+,-n.
2 (address)
LU
fil
CC (section) c (lot number) (grave number)
jo Name of Sexton or Person in Charge of Premises C I, r• Jail rvt rt"
IL (please print)
>: Signature Aviv, Title r(4-1*6'"4,1-
(over)
DOH-1555 (02/2004)