Turner, Francis A
L
NEW YORK STATE DEPARTMENT OF HEAL .
Vital Records Section Burial - Transit Permit
8.�
r{ Name First Middle Last Sex
,;r Francis Ralph Turner Male
Date of Death Age If Veteran of U.S. Armed Forces,
'f% March 29, 2015 86 War or Dates Korean
fto
0,, Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Suzanne Bergin
Address
%! 3167 Main Street,Warrensburg,NY 12885 _
� Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601
❑X Burial Date Cemetery or Crematory
May 16, 2015 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
on Transportation Shipment
as by Common Destination
Carrier
Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
11
Permit Issued to Registration Number
r-A Name of Funeral Home Regan Denny Stafford Funeral Home 01443
it., Address
53 Quaker Road, Queensbury,NY 12804
,; Name of Funeral Firm Making Disposition or to Whom
I;:
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
0„<4 Date Issued iAl2 \c O lc Registrar of Vital Statistics Cam, q. M c��
f (signature)
District Number Place a b�A 1r)/
l
-
I certify that the remains of the decedent identified above were posed of in accordance with this permit on:
W Date of Disposition 5/1 6/201.5PIace of Disposition Pine View Cemetery, Oueensbury, NY
2 (address)
U) Erie 23A 1
(section) (lot number) (grave number)
pName of Se on or Person in Charge of Premises Connie L. Goedert
Z (please print)
IllSignature / G' Title Cemetery Superintendent
(over)
DOH-1555(02/2004)