Silver, Issie NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
f Name First Middle Last Sex
.:ti
iiiK', Issie Ike Silver Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 19, 2015 84 War or pates _
{::, 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 Suicide Undetermined Pending
Circumstances Investigation
•1Medical Certifier Name Title
rj William Borgos MD
:$ Address
161 Carey Rd,Queensbury,NY 12804
Death Certificate Filed istrict Number Register Number
City, Town or Village Glens Falls 5601 q i -3
.....
❑Burial Date ;cmetery or Crematory
August 20, 2015 t"ne View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
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O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
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
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human rer wins d cribed ove as Indic.ted.
f:: Date Issued dis'r_ , /6 Registrar of Vital Statistics �_.r-, ` &27‹
ve r signature
▪ District Number 5t Q j Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition $/0116 Place of Disposition -a Uti,j rre-v.Iori,,_r
2 (address)
W
U)
CL (section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises As Kitif
Z please print)
W 4
Signature Title /*ii 1Y/(
(over)
DOH-1555(02/2004)