Murray, Dorothy c 1
NEW YORK STATE DEPARTMENT OF HEALTH ��
Vital Records Section Burial - Transit Permit
;,fi; Name First Middle Last Sex
Dorothy F. Murray Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 18,2017 89 War or Dates n/a
Place of Death Y Hos¢ital, Institution or
City, Town or Village Moreau Street Address Home of the Good Shepherd
Manner of Deathu_ki Natural Cause 0 Accident 0 Homicide E Suicide Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
0 Address
r A Death Certificate Filed District Number Register Number
City, Town or Village Moreau,NY 4562 - i(
0 Burial Date Cemetery or Crematory
Entombment August 22,2017 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O
and/or Address
E
Hold
N
O Date Point of
NEl Transportation Shipment
as by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
1> ` Permit Issued to Registration Number
`' Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
',.i,
si::A 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 rem escribe abwe as indicated.
%� Date Issued O J //k/ ) Registrar of Vital Statistics J(, C4,/t y
`,: (sigture)
i > 5 Liza-- Place 3�1 Aklho i�_S i AlY !(/Y 6 ,y JV J3b�
District Number
r;,ft
H I certify that the remains of the decedent identified above were disposed of in accordancei with this permit on:
UJ Date of Disposition -/ili(j�Pfuce of Disposition 4? Vi (Lot.,
(address)
U) gfnl►1
(section) (19t number) c (grave number)
Op Name of Sexton or Person in Charge of Premise Bif 1.., _)a+^t0*
Z (pleas print)Ili
Signature Title i 11614
(over)
DOH-1555(02/2004)