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Kelleher, Joseph
11 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joseph Dennis Kelleher Male Date of Death Age If Veteran of U.S. Armed Forces, January 29, 2017 78 War or Dates 1957-1958 Place of Death Hospital, Institution or 2= City, Town or Village Queensbury Street Address 95 Aviation Road ill Manner of DeathUndetermined Pending i1 QX Natural Cause �Accident H Homicide n Suicide n IL/ Circumstances Investigation w Medical Certifier Name Title Robert Reeves Dr. Address 3 Irongate Center,Glens Falls,NY 12801 Death rtificate Filed � � �� District Number Register Number City own ot)Village L�s��? j vrU (��'—) t ❑Burial Date Cemetery or Crematory January 31, 2017 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury, NY 12804 Date Place Removed ZZ ❑Removal and/or Held and/or Address H Hold N O Date Point of NTransportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above E Address Permission is hereby granted to dispose of the human r mains described above s,iin`dicated. Date Issued \ I -)Registrar of Vital Statistics � /t c , < )�J`l 1 II (signature) District Number (_per� Place / 0 ie-- a---( C �` F\ I certify that the remains of the decedent identified above were disposed of in ccordance ith this permit on: Z gru,00,-' (rrn, orW Date of Disposition ZI Zfaf"� Place of Disposition 1.,. 2 (address) W Cl) tt (section) n (lot number) (grave number) QName of Sexton or Person in Charge o Premises C 4r,i 561�lit Z ,r (pie se print) W L L Title fRE�► 2 Signature (over) DOH-1555(02/2004)