Morrisey, Michael NEW YORK STATE DEPARTMENT OF HEALTH l 6
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
?'��X Michael John Morrissey Male
Date of Death Age If Veteran of U.S. Armed Forces,
F March 31, 2006 38 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
0 Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W PAUL F BACHMAN MD
a Address
Warrensburg Health Center, Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 560/ /4/2—
Date Cemetery or Crematory
❑ Burial April 5, 2006 Pine View Crematorium
Address
0 Cremation ouaker Road Oueensburv, NY 12804-
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
Hold
Date Point of
0 ❑Transportation Shipment
C. by Common Destination
0 Carrier
- Date Cemetery Address
6 ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
68 Main St., P. 0. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
x Remains are Shipped, If Other than Above
w Address
O.
Permission is hereb granted to dispose of the human remains descri ee ind'
Date Issued D __ G Registrar of Vital Statistics
(signature)
District Number 5 O/ Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z t
W Date of Disposition L)f 4.,/0 L; Place of Disposition h,n<v.?i-✓ (tryra., `0r),,,.,
2 (address)
W
N
0 0 (section) (19t number) (grave number)
Name of Sexton or Person in harge of Premises (h s''S (h NI ti'
Z (please print)
W
Signature Title (re r+Nti At)