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Morrison Sr., Christopher NEW YORK STATE DEPARTMENT OF Hi ALTN„ _ 5 / Vital Records Section Burial Transit Permit Name First Middle Last Sex Christopher David Morrison Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, April 14, 2017 56 War or Dates -' Place of Death Hospital, Institution or 1. City, Town or Village Street Address 26 Leonard Street pit. Manner of Death Natural Cause ❑ Accident n Homicide I I Suicide n Undetermined IEl I Pending B. Circumstances Investigation Lit Medical Certifier Name Title 13 Thomas Portuese, Address 100 Broad St. Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village 5 60 ) 2. . i ❑Burial Date Cemetery or Crematory April 17, 2017 pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address 17,7 Hold ' Date Point of nTransportation Shipment by Common Destination Carrier ❑ Disinterment Date Cemetery Address Date Cemetery Address ❑ Reinterment ... x Permit Issued to Registration Number 4 Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 , ; Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom F—' Remains are Shipped, If Other than Above Address ix Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued I,'1 Registrar of Vital Statistics c� �� (signature District Number 56 e 1 Place )\!Ns To, `\ S 1 k.i certify that the remains of the decedent identified above were disposed of in accordance with thisnn permit on: 17-iii Date of Disposition 04/1W/2017 Place of Disposition Quaker Road Queensbury,NY 12804 P,Z)p�, -1 (address) (section) i (lot number) (grave number) ci Name of Sexton o person in Charge of Premises — t1 rJ--.- 610-1 e_ (please print) ` Signature ,i�i :: .�� Title - 2 a/ (over) DOH-1555 (02/2004)