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DuFour, Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit Vital Records Section % Name First Middle Last Sex %'tt Joseph A. DuFour Male ' Date of Death Age If Veteran of U.S. Armed Forces, "fA October 7, 2013 89 War or Dates Army 'f"` Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address 22 Gage Ave Manner of Death A Natural Cause I l Accident — Homicide Suicide Undetermined Pending — — Circumstances Investigation Medical Certifier Name Title ,. Glen Anderson , r Address f:. 161 Carey Road,Queensbury,NY Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY 5601 7 ©Burial Date Cemetery or Crematory Ell Entombment October 11,2013 St.Alphonsus Cemetery Address ❑Cremation Pine Street, Queensbury,NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address H Hold Q Date Point of W n Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Renterment Date Cemetery Address n Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 '':1 Address 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address w i Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued GC ` �'l f3 Registrar of Vital Statistics (�7 w.�-��c (signature) i DistncL;,tmber ,531 , Place Glens Falls,NY 1 s iF I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ui Date of Disposition 1011\ Place of Disposition li314 t. c I Q 0 eafAS 1 W (address) CO ?CZes 2Z. 3 O (sectje>�i �\ .Arenber) (grave number) ZName of Sex or Person in Charge of Premises �`' LU ` L � ---�/ (Please print) Signature � Title - � Z1 � (over) DOH-1555(02/2004) i 1111111111111111114