O'Neil, Murry Royce k 3b
N EW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Murry Royce O'Neil Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/23/2020 90 Years War or Dates 1951-1951
Place of Death Hospital,Institution or
W City,Town or Village South Glens Falls Village Street Address 4 Leland Street,South Glens Falls Village,New York 12803
p Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
Gerard Abess MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village South Glens Falls Village 4524 6
Cemetery,Crematory or Facility Name
04/27/2020 Pine View Crematory
❑Burial Date
Entombment Address
ICremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or and/or Held
l- Hold Address
O
IL Date Point of
co ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 101078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition orto Whom
IH Remains are Shipped,If Other than Above
Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/26/2020 Registrar of Vital Statistics Sf---on Ke&er(EYectronicaf S6r=4
(signature/
District Number 4524 Place South Glens Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZW Date of Disposition qjZj 110 Place of Disposition 4 ZAV f+�--
(address)
W
(section) lot number/ (grave number/
Name of Sexton or Person in Charge of Premises Ift'
Z (plea print/
W Signature Title
DO H-1555(ol/18)p 1 of 2
?ublic Health Law Sec. 4145(2b) 0 13 6 3
Zeceipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit I
Official Funeral Directors Reg.or License#
POTTER
Lot No. 2p_0
ddress ve . N.Y.Glens Falls 1•� Section No.
1)8WebsterA , Falls,
N.Y.
Delcour Potter Plot New Kenesaw
late 6/12/62
Approximately 100Superficial ft. @ $1.30 per sq.ft.=$130.00
,ocation Bounded on n/w by Rickett4 lot; on q/e by Tnwn%-rri 1 ot; on /w by grass p
n/e vacant
orner Posts
.emarks
teed No. (and changes) 824
ayment Record
paid in full 6/12/62-
%e / o lac;�.
316 79J - oJa1
Form No. 01
Record of Interments
5
6
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Murry O'N it 4/30/2020
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O;Neil
NAME Murry O'Neil
LF Age: 90
Lot Owner:
Delcour Potter
Lot# Grave#
New Kenesaw 20C 3
Case:
URN
Died: 4/2 3/2 0 2 0 Interred:4/3 0/2020
Funeral Home: M.B. Kilmer
Cemetery:
Pine View