Morris, Paul I
rtlE\ YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul Edward Morris Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/31/2018 87 War or Dates Army - L LAS
°` Place of Death Hospital, Institution or
City, Town or Village City of Glens Falls,NY Street Address City of Glens Falls Hospital,NY
Manner of Death Natural Cause (Accident n Homicide 1 Suicide n Undetermined n Pending
I Circumstances Investigation
Medical Certifier Name Title
Donald Merrihew MD
0# Address
,'':4 319 Bay Rd.,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village City of Glens Falls,NY
®Burial Date Cemetery or Crematory
November 5,2018 Pine View Cemetery
El Entombment Address
❑Cremation Quaker Road,Queensbury,NY 12804
Date Place Removed
Zn Removal and/or Held
and/or Address
H Hold
8)
0 Date Point of
N n Transportation Shipment
'p by Common Destination
Carrier
n Disinterment Date Cemetery Address
[i Reinterment Date Cemetery Address
,, Permit Issued to
Registration Number
y �, Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
14:fi Name of Funeral Firm Making Disposition or to Whom
. Remains are Shipped, If Other than Above
Address
irt
Permission is hereby granted to dispose of the human remains d scribed above n icated.
Date Issued //��'//�/d" Registrar of Vital Statistics � .' .
,, (signature)
District Number �0/ Place l / /4, /() /
w
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
1/1 Date of Disposition 1 1 /5/2 01 8 Place of Disposition Pine View CPmP t Pry Qn PPn sbu ry NY
2 (address)
LU
0 Hudson #1 30-C 1
(section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises Conn i P T. noPdPrt
Z (please print)
W Signature 44(,(,L4 (,t�p
. Title rPmPtpry upPrintPr,i nt
(over)
DOH-1555(02/2004)