Durkee, Rodney NEW YORK STATE DEPARTMENT OF HEALTH , • # l tb
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rodney Durkee Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 29, 2012 58 War or Dates
1,,... Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death Natural Cause Accident Homicide Suicide Undetermined x Pending
W Circumstances Investigation
ku Medical Certifier Name Title
O Timothy Murphy,Coroner
Address
52 Haviland Ave,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 ) (-13
❑Burial Date Cemetery or Crematory
March 27, 2012 j Pine View Cemetery
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
�' Hold
N
O Date Point of
5 Transportation Shipment
5 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
h- Remains are Shipped, If Other than Above _
2 Address
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Permission is hereby granted to dispose of the human remains described above as,indicated.
Date Issued (-1/3 A'.Z Registrar of Vital Statistics L)C-Adt4n--12.. (4 J.
(sign
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ,4r,,,� 9 tot, Place of Disposition '�'nnaUn-) Cowie(1�—
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a Name of Sexton or Person in Cha a of Premises /irl}k L/` .5;4.41+'
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W Signature AL Title Ci2v7wfk�dQ/
(over)
DOH-1555(02/2004)