Langdon, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section tif 0 Burial - Transit Permit
Name First Middle Last Sex
Joseph C. Langdon Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 28, 2012 69 War or Dates
i: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
ci, Manner of Death i Natural Cause 0 Accident Homicide pi El Pending
MI Circumstances Investigation
g Medical Certifier Name Title
Address 66 rAl Sf. UIeM t ,0—<2, Q l (6F l
Death Certificate Filed ' District Number Regis Nuumber
6
City, Town or Village Glens Falls 5601 1
❑Burial Date Cemetery or Crematory
D Entombment July 31,2012 Pine View Crematorium
Address
®Cremation 21Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO C Removal and/or Held
and/or Address
E" Hold
N
O Date Point of
N n Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
I
Permit Issued to Registration Number
:3:' Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
: Name of Funeral Firm Making Disposition or to Whom
i:' Remains are Shipped, If Other than Above
Address
q': Permission is hereby granted to dispose of the human remains described bo a indicated.
Date Issued ,07/c3//t012-- Registrar of Vital Statistics A411' -co-
(signature)
District Number 5601 Place Glens Falls /kV l PQ/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition $-1-n Place of Disposition 17440,,,. 6.., ,rlu►..
W (address)
U)
Lt (section) Aribt
,(lot umber) S (grave number)
pName of Sexton or Person in Charge f Premises r• lh,��"
Z 44,--
(please print)WSignatureTitle C MArT�
(over)
DOH-1555(02/2004)