Whiting, Edward NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward Whiting Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 12, 2012 86 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
aManner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
I Circumstances Investigation
W Medic Certifier Na Title
L3 Address\y---Y---,-,--6 1 YJ
Death Certificate Filed t 4istrict Number Register Number
City, Town or Village Glens Falls,NY 5601 ,65'
❑Burial Date Cemetery or Crematory
February 14, 2012 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
N
0 Date Point of
N1 !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 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
OC
°' Permission is hereby granted to dispose of the human remains desc ib d bboo as ' ' ated.
Date Issued QZ iyAo/z Registrar of Vital Statistics
/ (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:
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u.l Date of Disposition its iS i Lott_Place of Disposition ` ►.4 U Cw -{6gw..
2 (address)
W
co
CC (section) (lpt number) ( (grave number)
cp Name of Sexton or Per n in Charge o Premises ibr+�� h*' "'ep-tt4
Z (please print)
W L Title rile rt ( -T VI_
Signature r
(over)
DOH-1555(02/2004)