Delaporte, Edward tf
NEW YORK STATE DEPARTMENT OF HEALTH �t
Vital Records Section etBurial - Transit Permit
Name First Middle Last Sex
Edward Nicholas Delaporte Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 14,2011 85 War or Dates WWII
li— Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death "VI Undetermined Pending
W � Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
G MftrgEd VA121(1kW IUD .
Address
10 -rem c5fRo5r. ( (eck f. cvaaI
Death Certificate Filed District Number Register umber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
E. Entombment January 18,2011 Pine View Crematorium
Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
tn
O Date Point of
u) 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 Funeral Home 01464
Address
53 Quaker Road,Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
2 Address
tX
O.
Permission is hereby granted to dispose of the hum remai s descri ed above as ndi <ted.
Date Issued O el Registrar of Vital Statistics (jam _ G 'e
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above ere disposed of in accordance with this permit on:
tuDate of Disposition AN)gi jdii Place of Disposition Pr%(At,..; C .c1o=;u—
W (address)
cn
te
(section) (lot nu r) (grave number)
Q Name of Sexton or Person in Ch ge of Premises nO-cf}ur .,,, -
Z , i (please print)
Ili Signature Title Crtettiv4
(over)
DOH-1555 (02/2004)