Webb, Edward f 5
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle , Last Sex
;i?. . Edward J Webb Male
irr Date of Death Age If Veteran of U.S. Armed Forces,
:::rr January 29, 2016 68 War or Dates Airforce
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 1 Manor Drive
Manner of Death
X Natural Cause Accident Homicide Suicide Undetermined IL
I Pending
CircumstancesInvestigation
Medical Certifier Name Title
Patricia Auer
'fr' Address
316 Carey Road,Queensbury,NY 12804
:r•
A Death Certificate Filed District Number FjeSter Number
;3: City, Town or Village 5657 f
❑Burial Date Cemetery or Crematory
February 1, 2016 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Glens Falls, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
co
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
,j Permit Issued to Registration Number
;;r; Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
,'x; Address
:f:
::;:r 407 Bay Road, Queensbury, NY 12804
;r : Name of Funeral Firm Making Disposition or to Whom
i'''' Remains are Shipped, If Other than Above
Address
:::: : Permission is hereby granted to dispose of the human eet ains describedj-.if
alove as indicated.
.. c 1 c)O 1 to 9 t ')� c. � � �.!
����� Date Issued � l Re istrar of Vital Statistics
Si.
(signature)
; {�r: C `�
K: District Numbe �''1� Place C) Cst� lac D.'J
I certify that the remains of the decedent identified above were disposed of in accorda 'ce th this permit on:
WDate of Disposition .0 3111, Place of Disposition J711.4 0Atu.' (left Q-0)e,...-
2 (address)
W
Cl)
IZ (section) p/ (lot number)( (grave number)
QName of Sexton or Person in Charge f Premises c`)63 31N/ -
Z ()ase print)
ILI aSignature 41 Title ` 'AVIT►L
(over)
DOH-1555(02/2004)