Morgan, Erika NEW YORK STATE DEPARTMENT OF HEALTH ! /g
Vital Records Section Burial - Transit Permit
7 Name First Middle Last Sex
Erika Ursula Morgan Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 19, 2014 77 War or Dates
Place of Death Hospital, Institution or
W City, Town o AM Hudson Falls Street Address 20 Delaware Ave
W Manner of Death Natural Cause ❑ Accident 0 Homicide ❑ Suicide 0 Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
G1 John Stoutenberg MD, M.D. Dr.
Address
102 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town o rag- Nudcd,, g.1 LL 57 6. / 9
❑Burial Date Cemetery or Crematory
November 20, 2014 Pine View Crematorium
,_ ❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑
Removal and/or Held
• and/or Address
{ Hold Pine View Crematorium
CO Date Point of
il ❑Transportation Shipment
_# by Common Destination
E: Carrier
ElDisinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I-. Remains are Shipped, If Other than Above
• Address
ix
W:;
0"' Permission is hereby granted to dispose of the human rem ins described above as indicated.
Date Issued //-� 0 -a u i'1 Registrar of Vital Statistics • a.
(signature)
District Number 6 4, Place 1/i //r b.e. f , Jso n PA 7/S
{ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
{'�j; Date of Disposition 11/20/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
Ca_
i (section) (lot number)r) (grave number)
Name of Sexton or Person in Charge of Premises l.�r,step4r J=Nr+
�1 '(please print)
al Signature Title 61 !'(,
(over)
DOH-1555 (02/2004)