Briggs, Nelson NEW YORK STATE DEPARTMENT OF HEALTH 1 4 y/l
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Nelson Briggs Male
Date of Death Age If Veteran of U.S.Armed Forces,
i, October 9, 2018 Ej War or Dates
Z Plac- - -.ath Hospital, Institution or �'
W Cit Tow , or Village Granville Street Address Home { ., (. (,�rj/y !Qr /2
0 Man - of Death IX. Natural Cause n Accident n Homicide nSuicide I I Undetermined n Pending
W Circumstances Investigation
U Medical Certifier Name Title
Address
6S I cti<`� ey S7,�-��
Death Certificate Filed District Numbers,/ Register Nrn r
City,Town or Village Granville ` '
n Burial Date /O//Sf 20/� 71 Ce etery or Crematory
/ areu/-Poo RC'el-PeyL/dK7
—1 Entombment Address
Cremation 6 Lt3 at �u-PE, l S&y
4 Date Place Removed
0 n Removal and/or Held
and/or Address
1' Hold
0 Date Point of
0 lill Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
6 E Disinterment
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
F= Name of Funeral Firm Making Disposition or to Whom
E Remains are Shipped, If Other than Above
IX
W Address
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 101 I l 1. bt 2 Registrar of Vital Statistics
(signature)
District Number
; �J'fJ Place Granville,Nework �`
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I- ,� p
UDate of Disposition /° hz It8 Place of Disposition �Y,teu„-' �t"`rt0`"^i
2 (address)
W
N
0 (section) (lot number) ++ ( ave number)
0 Name of Sexton or Person in Charge of Premises gr; r 3emett
Z (please print)
W Signature Title (PA (over)
DOH-1555 (02/2004)