Emblidge, George t
it 3 r
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George T. Emblidge Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 3, 2017 93 War or Dates 1942-1946
Place of Death Hospital, Institution or
. City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of DeathIX1E—I Natural Cause n Accident _Homicide pi Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
David Cunningham MD
Address
3 Irongate Center,Glens Falls,NY 12801
Death Certificate Filed District Number f\ I Register ber
City, Town or Village Glens Falls, NY L.
❑Burial Date Cemetery or Crematory
May 5, 2017 Pine View Crematorium
❑Entombment -Address
CI Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
2 and/or Address
Hold
t
0 Date Point of
g1-1
I 'Transportation Shipment
0 by Common Destination
Carrier
n Disinterment Date Cemetery Address
Renterment Date Cemetery Address
0. Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
474
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
:,.:; Address
Jjo:
;;' Permission is hereb granted to dispose of the human re ains d cribed ab a as indi ted ��
Date Issued 61" t Registrar of Vital Statistics �' �.
l si ature)
District Number re J�✓�C1 / Place fajii
I certify that the remains of the decedent identified above were di osed of in accordance w' this permit on:
WDate of Disposition S I g In Place of Disposition 'f j'u J( ✓ .1.o41- v�Or c ,
2 (address)
)
Ce (section) rrf/(lot number) (grave number)
pName of Sexton or Person in Charge of Premises GA/J .eir j1'
Z (pl se print)
ILI
Signature Title f k+ X
(over)
DOH-1555(02/2004)