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Morgan, Richard it NEW YORK STATE DEPARTMENT OF HEALTH - i -r-7 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard K. Morgan Male Date of Death Age If Veteran of U.S. Armed Forces, October 25, 2016 74 - War or Dates 1 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death X❑Natural Cause ❑ Accident ❑ Homicide 0 Suicide ❑ Undetermined El 1-1 Pending ill CircumstancesInvestigation Medical Certifier Name Title KJ Joanna Erwin, KPriC, Address 1 10/ QELI Row Qf r7t Death Certificate Filed District Number 6 Register Number City, Town or Village Glens Falls ' !2. ❑Burial Date Cemetery or Crematory October 26, 2016 Pine View Crematory ❑Entombment Address - -©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of 4. ❑Transportation Shipment by Common Destination Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment F_ Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address I: Permission is hereby granted to dispose of the human remains described above as,,indicated. Date Issued 10)2(, /20/6Registrar of Vital Statistics �cA.A4-,,..q., (signature) District Number 5 6 0 I Place 6 CAS VC.,< <) S , &' y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 10/26/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) /'l (lot number) (_ (grave number) Name of Sexton or Person in Charge of Premises G lira{o f Jihi l " (pletase print) Signature 4 'f Title (1404W" (over) DOH-1555 (02/2004)