Morgan, Doris NEW YORK STATE DEPARTMENT OF HEALTH E.-4 ��
Vital Records Section Burial - Transit Permit
Name First Middle . t Last Sex
Doris F Morganpupate_
Date of Death Age If Veteran of U.S.Armed Forces,
F January 22, 2006 94 War or Dates
Z Place of Death Hospital, Institution or •
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
O Manner of Death E Natural Cause ❑ Accident ❑ Homicide Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
U
Medical Certifier Name Title
W PE)(At/ei doe- -1''G.lil ns ,1
Q Address
Io0 :14-0-k 05i• a/ext a.11..$. •
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5 60, 0
Date Qremato •
Burial Q 1 I ZL/ /0 � �° (0,t)
� �.n
❑Entombment / l__.�e8 ,cble_iu A
Address /�
m RI Cremation Q 'i /Z- ,e.. �LA 62tie szieiar, N/y /2& y
g Date Place Removed
0 ❑Removal and/or Held
•
and/or Address
Hold
0 Date Point of •
0 ❑Transportation Shipment
d by Common Destination
iCarrier
Date Cemetery Address
a ❑ Disinterment
Li Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home Off,8,,_,
Address
407 Bay Road, Queensbury, New York 12804
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
X
W Address
O.
•
Permission is hereby granted to dispose of the human re ins described above as di•:ted.
Date Issued 1 / Zi-I /0 6 Registrar of Vital Statistics ir_..-Qp C
(signature)
District Number 5 b 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 l Y���
i• Date of Disposition 1-2 9_.IJ Place of Disposition /21 f £(1) addre sE�P 11
R.'�
W ( )
N
se 0 ( „ction) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises 6 6-A K1 "
2 Glaz..A.A../
(please print)
LI
Signature Title C. &
(over)
DOH-1555 (02/2004)