Murphy, Joshua 11
NEW YORK STATE DEPARTMENT OF HEALTH ` ' '`' # VIZ_
Z
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joshua T. Murphy Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 23, 2014 39 War or Dates
Place of Death Hospital, Institution or
1 City, Town or Village Queensbury Street Address
' Manner of Death Natural Cause ❑ Accident n Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
' Medical Certifier Name Title
Timothy Murphy,
' Address
52 Haviland Ave Glens Falls, NY 12801
Death Certificate Filed District Nu)Number Rr inter Number
City, Town or Village Queensbury
❑Burial Date Cemetery or Crematory
October 27, 2014 Pine View Crematory
0 Entombment
Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
1 Date Point of
❑Transportation Shipment
by Common Destination
Carrier
ElDisinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
It
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
,f Permission is hereby granted to dispose of the human rLviains described ve as indicated.
Date Issued I o 1Z?/oZO1 Registrar of Vital Statistics et .,` q
`__, (signature)
DistrictNumbercL9 'c Place I O
I certify that the remains of the decedent identified above were dispose in acc dance with this permit on:
Date of Disposition 10/27/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises ti Se t
/� (please print)
Signaturei. Title Cat Off ,
(over)
DOH-1555 (02/2004)