Nason, Maurice e - e 3o 44
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Maurice Nason Male
Date of Death Age If Veteran of U.S.Armed Forces,
June 28,2006 94 War or Dates WWII
Place of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital
Z City, Town or Village Street Address
W Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
G Circumstances Investigation
V Medical Certifier Name Title
W Scott Biasetti Dr.
G Address
100 Park St.,Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 3 0 5
0 Burial Date Cemetery or Crematory
7/3/2006 Pine View Cremation
❑ Entombment Address
0 Cremation Queensbury,NY
Date Place Removed
Z ❑ Removal and/or Held
O and/or Address
P. Hold
N Date Point of
d ❑ Transportation Shipment
W by Common Destination
a Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Sullivan Minahan&Potter 01734
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
- Address
GG
Ili
• Permission is hereby granted to dispose of the human remains describeZzle)s ry i�cat,
Date Issued S 13 0l 0 D Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H 7
Z Date of Disposition i/�/r:b Place of Disposition � l n.v iP u., %._re'-stG-1„re+
1 (address)
W
N (section) . (lot number) (grave number)
IX
O Name of Sexton or Person in Charge of Premises
INr-,5 Seri t
G (please print)
Z ' i
W Signature C' fkA.,t.c—' Title (rtm.4.-'
DOH-1555 (02/2004) (over)