Murphy, Edward {
NEW YORK STATE DEPARTMENT OF HEALTH 0..Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward John Murphy Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 16,2013 67 War or Dates
F. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death 0 Natural Cause Accident Homicide Suicide Undetermined n Pending
W Circumstances Investigation
W Medical Certifier Name Title
Trevor E.Black
Address
Glens Falls Hospital,Glens Falls,NY 12801
Death Certificate Filed District Number Registe9Npmbrz.
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
October 21,2013 Pine View Crematory
0 Entombment Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z El Removal and/or Held
p0 and/or Address
Fr) Hold
0 Date Point of
y 0 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit 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
Remains are Shipped, If Other than Above
Address
MI
EL Permission is herebygranted to dispose of the huma remains d: cribed ab ve as Indic. ed.
Date Issued l /w /3 Registrar of Vital Statistics ice,-,
(signature)
District Number 560i Place Glens Falls
I certify that the remains of the decedent identified above w:'e disposed of in accordance with this permit on:
�Z „gam" Cr. -
Date of Disposition jOIZ'Z[13 Place of Disposition
W (address)
CO
te
p0 (section) 74;t(lotmber)S; a (grave number)
Name of Sexton or Person i Charge of P emises
Z (Tease print)
W
Signature Title Ca lintliik
(over)
DOH-1555(02/2004)