Collins Sr., Edward NEW YORK STATE DEPARTMENT OF HEALTH 71.
Vital Records Section Burial - Transit Permit
Ai, Name First Middle Last Sex
4 '. Edward C. Collins Sr Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 20,2018 77 War or Dates Army
Plac Bath ( ' Hospital, Institution or
• Ci Town VillageMc..-
?(k,L&L. f Street Address 30 Hilton Drive
• Manner of Death n Natural Cause E Alcident Homicide E Suicide n Undetermined n Pending
Circumstances Investigation
F Medical Certifier Name Title
Gerald Abess,MD
Address
Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Moreau,NY 4562 /3
❑Burial Date Cemetery or Crematory
March 22,2018 Pine View Crematory
Entombment Address
I Cremation Quaker Road,Queensbury,NY
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
th
O Date Point of
IL c n Transportation Shipment
p by Common Destination
Carrier
��-1 Date Cemetery Address
t l Disinterment
Reinterment Date Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Regan and Denny Funeral Home 01444
Address
94 Saratoga Ave,South Glens Falls,NY
Name of Funeral Firm Making Disposition or to Whom
"` Remains are Shipped, If Other than Above
Address
n.
r .
>l, Permission is hereby granted to dispose of the human remains descri' - al).ve as indicated,
Date Issued C3JaiJa (,/,D/8 Registrar of Vital Statistics ' lit, le
k ` (signature)
O
District Number 4562 Place Town of Moreau,NY
g
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z G�
W Date of Disposition 3`7311 f Place of Disposition ft.tt -
u
(address)
W
ot (section) (lot umber) (grave number)
aName of Sexton or Person in Charge of Premises �1c'
Z` (plf ase print)
ILI 4Signature /4 Title / ►tibt
(over)
DOH-1555(02/2004)