Morgan, Catherine NEW YORK STATE DEPARTMENT OF HEALTH Iii Vital Records Section Burial - TransitPermit
ffr Name First Middle Last Sex
Catherine Morgan Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 11, 2014 78 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 'XI Natural Cause n Accident E Homicide Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John Stoutenburg,MD
t)''b Ca(lE sd{i .Address 1(..erl�. Fa t i s ii u ` ) ��c
Death Certificate Filed District Number (Register Number
City, Town or Village Glens Falls 5601 2 Z
❑Burial Date Cemetery or Crematory
❑Entombment January 13, 2014 Pine View Crematorium
Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
H Hold
Cl)
O Date Point of
N U Transportation Shipment
a 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 01444
Address
94 Saratoga Avenue, South Glens Falls, NY 12803
'1 Name of Funeral Firm Making Disposition or to Whom
bj Remains are Shipped, If Other than Above
Address
1 Permission is hereby granted to dispose of the human remains described abovq as indicated.
Date Issued I j i 3// Registrar of Vital Statistics A C a. W (sig
.�f
n ure)
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:
Z
iu Date of Disposition I/it4ftq Place of Disposition ems. iht,-J atpra40:rAr..
W (address)
Cl)
W (section) 9 (l pt number) — (grave number)
Q Name of Sexton or Person incharge of Premises >> ! twnlf -
Z lease print)
W `�Si nature L --�
9 Title t itillijati
(over)
DOH-1555(02/2004)