Morris, William J t t 1Lt1
NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
William Joseph Morris Male
Date of Death Age If Veteran of U.S.Armed Forces,
July 22,2013 73 War or Dates 1960-1964
Place of Death Hospital, Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
el Manner of Death o Natural Cause Ej Accident 0 Homicide 0 Suicide Undetermined ni Pending
Circumstances Investigation
w Medical Certifier Name Title
T.Coppens
Address
Irongate,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 c/9
❑Burial Date Cemetery or Crematory
July 26,2013 Pine View(Crematory
Erdorr>bcner>t Address
®Cremation Quaker Road,Queensbury,,NY 12804
Date Place Removed
Z El Removal and/or Held
and/or Address
E Hold
4 Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
0 Disinterment Date Cemetery Address
Renterment 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
F Remains are Shipped, If Other than Above
Address
W
aPermission is here y granted to dispose of the human remains descr'bed abo as ' c led.
Date Issued 2 29/3 Registrar of Vital Statistics 4 �
(signature)
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:
wDate of Disposition 1 -. -'t) Place of Disposition '2D.401M..l t0'\
W (address)
U
p (section) // .(lot number) (grave number)
ZName of Sexton or Person ' Charge of Premises {►r.i outfi
W (= )
Signature Title C12e►1prTOZ
(over)
DOH-1555(02/2004)