Corrigan, Edward NEW YORK STATE DEPARTMENT OF HEALTH ; 4LIcT
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward P. Corrigan Male
-- Date of Death Age If Veteran of U.S. Armed Forces,
August 5, 2013 72 War or Dates
(""" Place of Death Hospital, Institution or
W City, Town or Village Hudson Falls Street Address 1 St. Paul's Drive,Apt 7G
Lill
Manner of Death LurrlNatural Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
Robert P Reeves_MD.,
Address
Three lrongate Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 5 el a C Q 9
❑Burial Date Cemetery or Crematory
August 7, 2013 Pine View Crematorium
Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
Hold
t4 Date
0 Point of
eL n Transportation Shipment
CO by Common Destination
0 Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
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
I— Remains are Shipped, If Other than Above
2. Address
CK
WCL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued -w13 Registrar of Vital Statistics C _`"Y'""`-` , .
(signature)
District Number 5?4' Place \)L VI Il s�)-
�' I certify that the remains of the decedent identified abo e were disposed of in accordance with this permit on:
w_ Date of Disposition $I� 3 Place of Disposition CiarmiOrt .,
W= P �� p i cN,✓
LLI_ (address)
CO
l (section) (lot number) (grave number)
i�t 9 l `�`1 l
Name of Sexton or Person in har a of Premi s r� r Sirtt
Z' (�1lease print)
W' Signature Title CZtMPct02
(over)
DOH-1555 (02/2004)