Morse, George NEW YORK STATE DEPARTMENT OF HEALTH i
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George D. Morse Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 25, 2012 61 War or Dates
FPlace of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
CI Manner of Death 1771
j Natural Cause Ej Accident El Homicide Ei Suicide 0 Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
Mark Hoffman MD,
Address
420 Glen St. Glens Falls, NY 12801
Death Certificate Filed District Number j 0 Register Number
City, Town or Village O 1 5 Ct Z
❑Burial Date Cemetery or Crematory
December 28, 2012 Pine Vew Crematorium
❑Entombment Address
MCrerr.atiop Queensbu.ry,NY 12804
Date Place Removed
Removal and/or Held
a and/or Address
F. Hold
CO Date Point of
eLri Transportation Shipment
Cl) by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
H° Remains are Shipped, If Other than Above
2 Address
W
Permission is hereby granted to dispose of the human remains described above as it dicated.
Date Issued t Z- 1 2-6 j 1 z Registrar of Vital Statistics w C'.,e
(signature)
District Number 56o ) Place 6 �S �c� ,` 5/ 7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition IZ ll'it Place of Disposition fjL/ vi C.r sr v_
2 (address)
W'
tl?
d (section) .(lot number) - (grave number)
Ci Name of Sexton or Person 'n Charge of Pre ises c, 3htNif
J (pl ase print)
W Signature Title CeigMftoiL
(over)
DOH-1555 (02/2004)