Bittman, Melvin `Itrr/ . , it13J
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
: Name First Middle Last Sex
.j Melvin I. Bittman Male
r:r Date of Death Age If Veteran of U.S. Armed Forces,
November 27, 2014 91 War or Dates U.S.Army
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
iii Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Frances Bollinger,MD
Address
161 Carey Rd.,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 SSY5
❑Burial Date Cemetery or Crematory
December 1, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
-._.. Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
rr Address
407 Bay Road, Queensbury, NY 12804
:! Name of Funeral Firm Making Disposition or to Whom
..:+ Remains are Shipped, If Other than Above _
U Address
? Permission is herebygranted to dispose of the human remains de ib d ove i dicated.
,f P
.. Date Issued ///a O1Y Registrar of Vital Statistics , 2�
'r`,;;; (signature)
F: District Number 5601 Place Glens Falls,NY
Asti
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition (Z-i-i I Place of Disposition iW li Cm i.—
Ill
(address)
U)
0 (section) ot S (grave number)
Qdr(17!_nimber)
Name of Sexton or Person in Charge of Premises tnri
Z (p/e�se print)
W XSignature Title CI?)cto PPR
(over)
DOH-1555(02/2004)