Corcoran, Edward 4i 5-0
NEW YORK STATE DEPARTMENT OF HEALTH le - ,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward J. Corcoran Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 26,2011 71 War or Dates
i... Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
• Dr.Joseph Mihindu,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Regis r mber
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
Entombment January 31,2011 Pine View Crematory
Address
Ell Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
Hold
O Date Point of
NTransportation 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
E Address
Permission is hereby granted to dispose of the human remains describbove s in • a ed.
Date Issued p7a7,wi/ Registrar of Vital Statistics %hJ
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition FE8 Zf ZOI+ Place of Disposition P„te U,e„i C 4{d tam
2 (address)
W
N
(section) A (lot numb (grave number)
pName of Sexton or Perso 'n Charge of Pr mises i c=b ter Je h
Z (please print)
W
Signature Title CRr tI t �L
(over)
DOH-1555 (02/2004)