Murphy, James 3g;3
NEW YORK STATE DEPARTMENT OF HEALTH �t:Vital Records Section °'' ' Burial - Transit Permit
, "`° .. V
Name First Middle i Last Sex
James ...lOs��h r Murphy
Male
Date of Death Age 'h" ,,, + If Veteran of U.S. Armed Forces,
April 30, 2016 82 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death Natural Cause Accident ❑ Homicide Suicide ❑ Undetermined Pending
VCircumstances Investigation
til Medical Certifier Name Title
la Philip J. Gara, Dr.
Address
318 Broadway Fort Edward 12828
Death Certificate Filed District Number Register lumber
City, Town or Village Fort Edward 'j 7 5--.1C-- Q2 /
❑Burial Date Cemetery or Crematory
May 2, 2016 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z Removal and/or Held
C and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
3 Carrier
, ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
X Address
te
w
I' Permission ik her y nted to dispose of the human r 'ns described a ve as i icated.
Date Issue Registrar of Vital Statistic
--- (signature)
District Numbec5--j Place, r)J—) l % -7 f
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 05/02/2016 Place of Disposition Quaker Road Queensbury,NY 12804
' (address)
W
CO
IZ (section) /1( (lot numper) (grave number)
0 Name of Sexton or Person in Charg of Premises G ftt 14
z
'please print) ,�7�
W9 Signature J� ' Title CV-
(over)
DOH-1555 (02/2004)