Morrissey, William NEW YORK STATE DEPARTMENT OF HEALTH ' '
Vital Records Section Burial - �ransit Permit
Name First Middle Last Sex
William E Morrissey Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/29/2016 49 War or Dates
I- Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address Albany Medical Center
0` Manner of Death Natural ❑ Undetermined ❑ Pending
alis] Cause ❑ Accident ❑ Homicide ❑ Suicide Circumstances Investigation
U Medical Certifier Name Title
p Kevin Elmer MD
Address
43 New Scotland Avenue Albany, NY
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 462
Date Cemetery or Crematory
❑ Burial 03/02/2016 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
H Hold
CO
0 Date Point of
a Transportation Shipment
Cl) ❑ By Common 0 Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Miller Funeral Home 01199
Address
6357 State Rte 30 Indian Lake, NY 12842
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CL
Date 03/01/2016 p Registrar of Vital Statistics rib abo a as ine�G��
n- Permission is herebygranted to dispose of the human remains desc
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 3/3 J/lo Place of Disposition e (A ) Gm4torv►"-
(address)
w
Cr CA
(section) lot number) (grave number)
0 SlAit Name of Sexton or Person in Charge of Premises atri-tyLr
MI
(please print)
Signature CA -"AO- Title afigenit
(over)
DOH-1555 (02/2004)