Morrison, George NEW YORK STATE DEPARTMENT OF HEALTH SO
Vital Records Section Burial Transit Permit
v- Name First Middle Last Sex
George A. Morrison Female
Date of Death Age If Veteran of U.S. Armed Forces,
7/9/2018 86 War or Dates Air Force _
z. Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 4 Fort Amherst Road _
Manner of Death Natural Cause ❑Accident ❑Homicide l l Suicide ❑Undetermined ❑Pending
Circumstances Investigation
, Medical Certifier Name Title
Tim Murphy,Coroner
Address
Glens Fall,NY
Death Certificate Filed District Number fjsgistgr Number
City, Town or Village Queensbury,NY 5657 1.
❑Burial Date Cemetery or Crematory
❑Entombment July 13,2018 Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
H Hold
tI) —_
0 Date Point of
Q.
❑Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
,' Permit Issued to Registration Number
' Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
y' Address
t.7
t 407 Bay Road,Queensbury,NY 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 11 D-1�Ql Wegistrar of Vital Statistics • �c: r\,9,.,
(signature)
: District Number f(q�'--) Place 6-c Cr-" ,_.
I certify that the remains of the decedent identified above were disposed of in a corda e with this permit on:
tuDate of Disposition 1113 I 1 f Place of Disposition Wu"' 4't -
W (address)
CA
X (section) (N number) (grave number)
pName of Sexton or Person in Charge of Premises ,,, S `'(A
`Z (plea print)
Signature G1 Title mV
(over)
DOH-1555(02/2004)