Morris, James NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section -: Burial - Transit Permit
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}{ Name First Middle Last Sex
{`, James Arthur Morris Male
g Date of Death Age If Veteran of U.S. Armed Forces,
13 August 17,2016 68 _War or Dates Vietnam
a' Place of Death Hospital, Institution or
City, Town or Village Queensbury, NY Manner of Death
Street Address 18 Sycamore Drive
cril Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined n Pending
Circumstances Investigation
I
Medical Certifier Name Title
Dr.Kayalar,MD
Address
r=< Queensbury,NY
r Death Certificate Filed District Number Register Number
oi
City, Town or Village Queensbury, NY 5657 q 7
if
❑Burial Date Cemetery or Crematory
❑Entombment August 19,2016 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z ❑Removal and/or Held
O
and/or Address
H Hold
N
0 Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
['Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
.. Address
M 53 Quaker Road,Queensbury,NY 12804
SI Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
0
Date Issued 7, t$ l aoi 1. Registrar of Vital Statistics 4 `-A'`.&.‘-*\
t•'> (signature)
'' District Number SL.s`) Place 0 j c c A s 104(i
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I certify that the remains of the decedent identified above were disposed%ofAILin accordance with this permit on:
Z 67,„4-ofH�..-
IL! Date of Disposition $��9�/b Place of Disposition �
Ili
(address)
CO
W (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises ,,darer, •-•.) awYit
Z (please print)
W nSignature Irk/ Title t'iZt jhtj PA
(over)
DOH-1555(02/2004)