Grant, Edgar NEW YORK STATE DEPARTMENT OF HEALTH Burial Records Section Burial - Transit Permit
Name First Middle Last Sex
Edgar J. Grant Male
Date of Death Age If Veteran of U.Srmed Forces,
8/19/98 91 War or Dates No
Place of Death Hospital. Institution or
City, Town or Village Queensbury Street Address Hallmark Nursing Center
Manner of Death��Natural Cause n Accident n Homicide n Suicide n Unmined n Pends
ing
Circudetermstances Invetigation
F Medical Certifier Name Title
O _ Robert H.Beaty MD
Address
2 Broad St. Glens FAlls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury • 5657 �-7
Date Cemetery or Crematory
❑Burial 8/21/98 Pine View Crematorium
Address
Cremation Queensbury,NY 12804 .
Date Place Removed
n Removal and/or Held
and/or Address
M Hold
Q Date Point of
]Transportation Shipment
0• by Common Destination
Carr for _
n Disinterment Date Cemetery Address '
n Reinlerrnent Date Cemetery Address
Permit Issued to Registration Number
Sullivan-Mianhan&Potter
Name of Funeral Monte 01837
Address------ -------- --- --
407 Bay Rd, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
4.
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Permission is hereby granted to dispose of the human ins de chi e e a i idicated.
Date Issued 8/21/98 Registrar of Vital Statistic
si lure)
District Number 5657 Place 0ueensbury,NY
I certify that the remains of the decedent identified above were disposed of in accorclance wilh this permit on:
W Date of Disposition Place of Disposition 7///ff�f 4.) ,R (0_76,,Z. v/r/
+ (address)
tl
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Er (section ) (I r - j (grave number)
QName of Sext i or Pets n in Change of Premises ._ (�
2 (please print) i
W Signature Title l' $/
DOH-1555 (10/89) p. 1 of 2 VS-61