Mullen, Stephen EW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Y Name First Middle Last Sex
Stephen E. Mullen Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 10, 2013 66 War or Dates US Army
} ' Place of Death Hospital, Institution or
Z: City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
• Manner of Death X Natural Cause Accident ' Homicide Suicide Undetermined n Pending
Circumstances Investigation
w Medical Certifier Name Title
01 Dr Coppens,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 62
l Burial Date Cemetery or Crematory
❑Entombment February 14, 2013 Pine View Cemetery
Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
t"..: Hold
U)
O Date Point of
n Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
a Address
U1
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2/1-a) i 3 Registrar of Vital Statistics L'J
(signature)
District Number 5601 Place Glens Falls,NY /02 .!
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WW• Date of Disposition2/1 4/1 3 Place of Disposition Pine View Cemetery
W (address)
u) Huron 7C 2
(section) (lot number) (grave number)
Op Name of Sexton or Person i Charge of Premises Michael Genier
Z 6 (please print)
Signature t v Title Superintendent
(over)
DOH-1555(02/2004)