Huntington, Edward Ili 7
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
r f Name First Middle Last Seale
ti•} Edward F. Huntington m
: Date of Death 12/30/2017 Age 86 If Veteran of U.S. Armed Forces, Korean
War or Dates
%-: Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 56 Wincrest Dr
• Manner of Death x Natural Cause Accident n Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
'r' William Tedesco MD
r
: f Address
. : Irongate Center Glens Falls, NY
Death Certificate Filed istrictNumber Register Number
tih r
City, Town or Village Queensbury I
(0Q
❑Burial Date Cemetery or Crematory !
01/02/2018 Pine View Crematory
❑Entombment Address
[ Cremation Queensbury New York
Date Place Removed
Z; Removal and/or Held
0 and/or Address
*.) Hold
a" Date Point of
5:n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
pi Reinterment Date Cemetery Address
} Permit Issued to Registration Number
... Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
,J{v Queensbury, NY
{:fc Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
sr Permission i hereby granted to dispose of the human remains described above as indicated.
r, Date Issued I 0- 1 I Registrar of Vital Statistics C�Q O P)lL�'
(signature)
., District Number cLoc�l Place )Q d- . C.\) L.L.f2_12._.r,d.D.A
I certify that the remains of the decedent identified above were disposed of accordan a with this permit on:
Z p `��
w, Date of Disposition 1/3 i ig Place of Disposition l inc Y' ../ e oc.�,
2 (address)
tJ
0.
O (section) 4 (lot number) (grave number)
Q Name of Sexton or Person in Charge of Pre ises ,., J 6-14tt
Z (pl se print)
Signature it it Title ( Mom/
(over)
DOH-1555(02/2004)