Fagan, Edward NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last Sex
::: ::: EdwarcG. Fagan Male
Date of Death Age........................If Veteran of U.S.Armed Forces;::::::.....................................................................
` ' March 23 1990. 82 War or Dates No
Place of Death Hospital, Institution or
iiia City,Town or Village Glens Falls, New York Street Address Glens Falls Hos ital
4 Cause of Death
ill
Congestive Heart Failure Due to A S C V D
l Medical Certifier Name Title
>d David H. Thompson M. D.
......................................:::::::Address�::::.......................................................................................................................................................................................................
88 Broad Street Glens Falls, New York 12801
rt cate Filed District Number Register Number
nii City,Town or Village Glens Falls New York 5601 i,._J
Date Cemetery or Crematory
®Burial
March 26, 1990 Oine View Cemetery
❑Cremation Address
Quaker Road Queensbury, New York 12804
Date Place Removed
0 Removal ': and/or Held
and/or Hold Ad-dre :::::::::::::::::::::::::::::::::::.::::::::::::::::::......::::.>.::::::::::::::::::.:::::::::::::::::::::::..:::::::::::..::.:::::::::::::::::::::::::::::.::::::::::::......:::::::::::,::::::::::::::::::::
::.H: Address
ii!!
:Q Date Point of
❑Transportation by ; Shipment •
CommonCarrier .............................................................................................................................................................................................
': Destination
Date.::::.....................................................
DI Disinterment Cemetery Address
...........................................:.:::Date:::::..................................................... ..............................................................................................................
...................................................................................................
❑ Reinterment Cemetery Address
:€: Permit Issued to Registration Number
Name of Funeral Firm James F. Singleton Inc. 01850
:...........:::.::.:::::::::. ..
....:::.:.::.:.::...::::.::....................................::::::::::..:.:::::::::....::.
Address ....:::::::......:::::.�::......:::::::::..::.::..::.::::::::::::::::::::...:....:::::::::::::
314 Bay..Road Queensbury,...New York....12804........................._....................................................
14 Name of Funeral Firm Making Disposition or to Whom
""' Remains are Shipped, If Other than Above
ALli
Address
Aiii
Mil Permission is hereby granted to dispose of the hum remain ;'described - .ove as indicated.
r
Date Issued March 26, 1990 Registrar of Vital Statistics 4 „ _'
(signature) —
:`'•
s District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
.
WDate of Disposition ,3-d b -y c Place of Disposition P,y t Vi 4J Cam. e-741e/ ) ,Q 4 t_ ,�s l � A2 y) At,, y
(address) I
f CA/ i 1,4- i 'z
(section) (lot number) (grave number)
Q
p Name of Sexto is erson in Char eg of Premises
Z ''�*�.� (please print)
W Signature -2 ,Y! ..„4f ,i Title -
DOH-1555 (9/86)p 1 of 2(formerly VS-61)