Salmon, Edward NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Edward John Salmon male
N. Date of Death Age If Veteran of U.S.Armed Forces,
gi June 3, 1992 77 War or Dates no
2 Place of Death Hospital, Institution or
tit City,Town or Village City of Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
ill Medical Certifier Name Title
p Richard Spitzer MD
.................................................................................................................................................................................................................................................................................
Address
iiiiiiiil 90 South Street, Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls d/ z , 9
.,_,,
Date Cemetery or Crematory
I Burial June 3., 1992 =-.- Pine View Cemetery
Address ........: ..:.:... . ....:. .......: ..:.:..:. .... ............
❑Cremation
Queensbury, New York
Z Date Place Removed
O, 0 Removal and/or Held
H and/or Hold :...:.:::..........
Address
co
Date Point of .:
N;El Transportation by Shipment
p Common Carrier
Destination
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc. 01602
iiiiiiiiiiii Address
gg 26 Quaker Road, Queensbury, N. Y. 12804
...........
H. .Name of Funeral Firm Making Disposition or to Whom
g' Remains are Shipped, If Other than Above
. Address
Permission is hereby granted to dispose of the human re ins described above as indicated.
gg
II Date Issued �p 1p Registrar of Vital Statistics yt,>( ..*( 744 ,..
(signature)
District Numb r Place '6-- .1 J 7�A/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition —,5` Place of Disposition / v ` `/c--G.>) ('�-/ve.-f i<)/� 43,,[CZ iv 5/3-0._y)�J Y
a. (address)
l �r /c c .sic, /
cc' (section) (lot number) (grave number)
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p- Name of Sex do o Person ' Charge of Premises 0 r.,> ..,11 y 62 _/-1--w s!1/Z-�`
Z (please print)
-La Signature / cs4. '•.) V L v Title . <_,., -
DOH-1555 (10/89) p. 1 of 2 VS-61