Loading...
Manning, Daniel NEW YORK STATE DEPARTMENT OF HEALTH IFlig `L7 Vital Records Section Burial - Transit Permit >' Name First Middle Last Sex Daniel J. Manning Male . Date of Death Age If Veteran of U.S. Armed Forces, July 12,2014 24 War or Dates Place of Death Hospital, Institution or City, Town or Village Town of Moreau Street Address 1 River Crest Road Manner of Death ❑Natural Cause ❑Accident n Homicide ❑Suicide n Undetermined Mc Pending Circumstances Investigation Medical Certifier Name Title > S• usan Hayes Mssa,Cornoer Address Saratoga Springs,NY } Death Certificate Filed District Number Register Number City, Town or Village Moreau 4562 (Q ❑Burial Date Cemetery or Crematory July 16, 2014 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z ❑Removal and/or Held and/or Address F' Hold N O Date Point of y ❑Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address »i P• ermit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address . 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom 1 R• emains are Shipped, If Other than Above Address Jr r Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued (TN-4 4 Registrar of Vital Statistics rn. C/ (signature) District Number 4562 Place Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition -7`(t.'N Place of Disposition att..; C iiCSra—. W (address) U) Ce (section) t number) ��"" (grave number) Q d:„,,,, Name of Sexton or Person in Charge of Premises �rhn/,4 Zit L (please print) W Signature Title Cl2+r;iif7 (over) DOH-1555(02/2004)