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Murphy Sr., Robert . ., 4 ?ao NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit s�. Name First Middle Last Sex toRobert Gordon Murphy Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2018 99 Years War or Dates 1944-1946 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title "" Stephen Perazzelli MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 408 ❑Burial Date Cemetery or Crematory 08/27/2018 Pine View Crematory ❑Entombment r Address vi®Cremation Queensbury, New York — Date Place Removed ,, ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment ,-- by Common Destination Carrier . •rfs 4.001004 411Ler.. ..... eat 1 Q Disinterment Date Cemetery Address • Q Reinterment Date Cemetery Address ii Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address A 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. ` Date Issued 08/27/2018 Registrar of Vital Statistics Rp6ertA Curtis(E(ectronica((ySigned) (signature) '. District Number Place ;-: 5601 Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition I l30 I IV Place of Disposition lJ,✓ l p ie,�ct{c... (address) ,.4 (section) (lot number) << (grave number) Name of Sexton or Person in Charge of Premises ��r,; f 5""4* 0-.4 (please print) 5 ASignature Title 8104041- (over) DOH-1555(02/2004)