Murtagh II, Scott I 4fe3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
Scott Allen Murtagh II Male
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 23 / 2018 44 War or Dates N/A
i- Place of Death Hospital, Institution or
City, Town or Village South Glens Falls Street Address 23 Hudson Street
ilja Manner of Death r—lI l Natural Cause 0 Accident Homicide IN Suicide � Undetermined 0 Pending
Circumstances Investigation
0.
Au Medical Certifier Name Title
Michael Sikirica MD
Address
50 Broad St, Waterford, NY 12188
>` Death Certificate Filed District Number Register Number
<`< City,Town or Village South Glens Falls
>< ❑Burial Date Cemetery or Crematory
>:; 10 / 25 / 2018 Pine View Crematory
0 Entombment Address
``iiii:iE.Cremation Queensbury, NY
Date Place Removed
*g❑Removal and/or Held
and/or Address
Hold
Date Point of
QA Transportation Shipment
by Common Destination
Carrier
`:.` Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
>' Address
402 Maple Ave. , Saratoga Sp. , NY 12866
>€ Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
i. Address
.
'"` Permission is hereby granted to dispose of the human rema" escribed above as indicated.
,12i. Date Issued /6/0?4//2O/8-Registrar of Vital Statistics
(signature)
District ifice21/ Place South Glens Falls New York
k-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI P Itti�16DispositionCL.. ( to-.--
Date of Disposition 2 Place of
(address)
iii
VI
ft (section) (lot number) ( (grave number)
et Name of Sexton or Person in Charge f Premises L 4���t�`', 11��'�'r
24 (please print)i.
W. Signature Title tgetr}pL
•
(over)
DOH-1555(02/2004)