McPherson Jr., Edwin "
NBWYDRK STATE DEPARTMENT OFHEALTH Burial
� Transit Permit
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Bureau of8io,�otht�e 'Vha| Records Sm��n ~~~ ^-- ^ ~~~^ ~~~ ~~^^
Name First Middle Lost Sex
Edwin �o�berouu Jr. � Male
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Age If Veteran of U.S.Armed Forces,
Place of Death
Hospital, Institution or
City,Town or Village Town of Northumberland Street Address RD #2, Pettis Road
Cause of Death
severe cranio - cerebral destruction
Medical Certifier Name Title
211 Church Street, Saratoga Springs, N.Y. 12866
Death Certificate Filed
District Number Register Number
City,Town or Village Town of Northumberland'.
Date Cemetery or Crematory
El Burial
12/23/87 Pine Crematorium
Address
Cremation
Town of Queensbury, N.Y.
Date Place Removed
and/or Held
Address
Date Point of
Transportation by..
Shipment
Destination
Date
emetery Address
Disinterment
Date Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Firm Brewer Funeral Home, Inc. 00243
Address
ame of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ddress
Permission Is hereby granted to dispose of the dead human remains described above as Indicated.
Date Issued Registrar of Vital Statistics
District Number Place x
|certify that the remains cf the decedent identified above were disposed of in accordance with this permit on:
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Disposition `7�� ^v /` � �lc��^��- � ^°�
W.
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(section) (lot number) (grave number)
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Name cdSo�u in Charge ofPremises ��*/Aj / | cv �'/
/ '/ (please print)
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