Manning, Warren NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First MiddleMiddle Robert Last Manning Sex male
ot Death 7 5::.::..............
Date
.................................... Age..._ _........::::::.If Veteran of U.S.Armed Forces,'.....
6
7
><:: 7/18/87
War or Dates ww II
it Place of Death city Of Hospital, Institution or
la City,Town or Village g Glens Falls i Street Address Glens Falls Hosp
D Cause of Death
l
acutecardiac Arrest f Me ' al Certifier N e Title
igi
Deal et cats File District Number Register Number
sz' City,Town or Village .- a_f �-6c) / 36 6
nal Date' l etery Orpremator
....-.tV ,47.................. .w-.. ........................ ........:...................:...:.......
❑Cremation
Z ii Date ,?la e;= oved
O; El d/
• •r Held
j-.; and/or Hold`..:........:....:.::,... ...,,:.:...............:....:............ ......,.::. .... . !............:..........................,. .
Address ::::...............:............................................ ..._
t/!;
O>.
n. Date Point of
(1):: ['Transportation by Shipment
p Common Carrier ..............:::..:...........:
Destination
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Date Cemetery Address
Permit Issued to l Registration Number
Name of Funeral Fir ✓ L G 9
::: >
s
:
i Nam of Funeral irnyma ' Dispos tion or to Vllk��
1 Remains are Shipped, If ther than Above
iitiji
Address
l'
ffii Permission Is hereby granted to dispose of the dead hu rema s descri ed above as indicated.
iiiiiiiii Date Issued -- / Registrar of Vital Statistics /7
signature)
District Number —311 / Plac ti4,..--,..002'��:e ��6C-0/
I certify that the remains of the decedent identified above were disposed of;.•-ccordance with this permit on:
F- R
Z Date of Disposition 7�",21--�/ Place of Disposition Pi•'N,t- !�i �/J ek�94]ram 2 )/ a Do4i 4,Y..Ajnd
2 , (address) / U
•: (section) (lot number) (grave number)
pi Name of Secton or Person in Charge of Premises /7.6,D,/� ! `7.Fr l
>.Z< (please print /'
w Signature f, '. O1n... l Title
DOH -1555(9/86)p 1 of 2(formerly VS-61)