Turpin, Richard NEW YORK STATE DEPARTMENT OF HEALTH L Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex Male
Richard L. Turpin
Date of Death Age If Veteran of U.S. Armed Forces,
3/16/2012 93 I War or Dates WWII
Place of Death I Hospital, Institution or
OitiOlown 000Inge Johnsburg Street Address Adk. Tri-County NH
Manner of Death[NaturalName Cause ❑Accident Homicide ❑Suicide
Title Undetermined ❑Pending
Circumstances Investigation
c. Medical Certifier J �› Jul b
Address
North Creek,NY
Death Certificate Filed ! District Number Register Number ij
QM Town Xr7 I X Johnsburg 5655 /
Date Cemetery or Crematory
❑Burial 3/20/2012 Pine View Crematory
Address
Ei Cremation i Queensbury,NY
Date Place Removed
fl❑Removal and/or Held
1. ..
!= and/or Address
t� Hold
44),,� Date Point of
N Q Transportation Shipment
Q by Common Destination
Carrier
El Disinterment ; Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Miller Funeral Home 01199
Address
6357 State Rte. 30, Indian Lake,NY 12842
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped. If Other than Above
Address
tti
Permission is hereby granted to dispose of the human remai s described ab as indicated.
Date Issued3) 0 (a Registrar of Vital Statistics "' C4.452
42
i_ (" I (signature)
Place /Q(,Q)! _o ` ok1�5 ht,L.r
`,1 District Number `.�(�55 I_
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3-J0'-oZot2 Place of Disposition l►W a ii!ec.J Crewof c ci,v'
g (address)
Ui
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CC (secti ) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises (r(WI M �, elk
Z �� (please prim
W Signature Title Cr-ervIG •
DOH-1555 (10/89) p. 1 of 2 VS-61