Durkee, Fred NEW YAK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Fred S. Durkee Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 22, 2013 96 War or Dates 1941 - 1945
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines At Glens Falls
pManner of Death X Natural Cause n Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
C Bernardo Villajuan
Address
, Glens Falls,NY 12801
Death Certificate Filed District Number Regier Number
City, Town or Village Glens Falls 5601 �c
CI Burial Date Cemetery or Crematory
December 27, 2013 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, ,NY 12804
Date Place Removed
ZO U Removal and/or Held
and/or Address
Hold
N
O Date Point of
05 7 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued /2/ 2 Ll 1/3 Registrar of Vital Statistics Lik.)
(sig ature)
District Number 5601 Place Glens Falls/ N`V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 1 2/27/1 3 Place of Disposition Pine View Cemetery
(address)
Cl)W Ondawa 6 C 1
0 (section) (lot number) (grave number)
pName of Sex on or Person in Charge of Premises Connie L. Goedert
(please Wint)
w Signature f&. .Q_ tti --eL Title SuperiYY�itenGlerit
(over)
DOH-1555(02/2004)