Hollis, Raymond Martin .. i ��b
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
James Edward Murphy Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/08/2019 60 Years War or Dates
�,. Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
ttp Mannerof Death RI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Michael Bell MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 528
Burial Date Cemetery,Crematory or Facility Name
12/10/2019 Pine View Crematory
Entombment Address
MCremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
F—N Hold Address
O
Go- Transportation Date Point of
f!) ❑
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
ll.. Remains are Shipped,If Other than Above
Address
Q
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/10/2019 Registrar of Vital Statistics oWen,?ndrewCurt&(EkctronicadySl wed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F— !�
W Date of Disposition /Z II 115 Place of Disposition 4W t`
(address)
W
N (section) (lot number) (grave number)
10 Name of Sexton or Person in Charge of Prem'ses r� �'"'
Z /p! se print/
W Signature Title `
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) w ' 13 1
Receipt
Human remains of ? E � delivered on , 20'1
Pine View Cemetery Representipg the funeral home named on burial permit
Official Funeral Directors Reg.or License#