Morehouse, Edward NEW YORK STATE DEPARTMENT OF HEALTH - # 7Z J
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward R. Morehouse Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 3,2018 75 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Chester Street Address 62 Panther Mountain Drive
p° Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
mil Circumstances Investigation
w Medical Certifier Name Title
O, Robert John French MD
Address
Two Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Chester 5652 l 3J
❑Burial Date Cemetery or Crematory
❑Entombment September 5,2018 Pine View Crematory
Address
ix Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
! Hold
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0 Date Point of
NI 'Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
E' Address
3809 Main Street,Warrensburg, NY 12885
`y Name of Funeral Firm Making Disposition or to Whom
Fit Remains are Shipped, If Other than Above
. Address
X
W.
cL
Permission is hereby granted to dispose of the human remains /-e1cribed above as indicated.
Date Issued C1-04 a01 T Registrar of Vital Statistics . , -li
�' (si rar ure)
District Number 5652 Place T/O Chester,NY
H 1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition q i b�l g Place of Disposition ?Mt eN.4._..
W (address)
N
a (section) A number) v.. (grave number)
Q Qf Name of Sexton or Person in Charge of Premises L Ii rsikA.- J p+
`Z /� (please print)
Signature �,�( 4-- Title Arts*rot
(over)
DOH-1555 (02/2004)