Briggs, Morwenna NEW YORK STATE DEPARTMENT OF HEALTH r
Vital Records Section � Burial - Transit Permit
Name First Middle Last Sex
Ideaensra In o(L,t+J e_n A A R Briggs Female
Date of Death Age If Veteran of U.S.Armed Forces,
F. March 17, 2013 86 War or Dates NO
2 Place of Death Town of Granville Hospital, Institution or The Orchard
W City,Town,or Village Street AddressNurs ing and Rehab. Center
G Manner of Death [j Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Jennifer Hayes MD
0 Address
10421 State Rout 40 Granville New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village 5ri56 (Z.
❑Burial Date March 21 , 2013 Cemetery or Crematory
Pine View Crematorium
❑Entombment Address
❑X Cremation 21 Quaker Road Queensbury New York 12804
2 Date Place Removed
0 ❑Removal and/or Held
and/or Address
F Hold
0 Date Point of
0 ❑Transportation Shipment
0. by Common Destination
Carrier
Date Cemetery Address
0 ❑Disinterment
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Ji11son Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
1-
Name of Funeral Firm Making Disposition or to Whom
Z Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
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Date Issued `�l lQ 1 otp 13 Registrar of Vital Statistics
( i re)
District Number 594e Place , •btu p+ Gcgr-\vA 11-e_
•
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
a �j ;�
W Date of Disposition �l/-/3 Place of Disposition /�i n02.- t//1►"r 4-I Cii/if-/Y/9"'h'2-7
2 (address)
lu
to
(section) t nu r)a. (grave number)
0
ZName of Sextonorit'ers n in Char e of Premises Z> be
W � ✓ (please print)
Signature s' O` t.,,�Title ►4-4 irk. 4-
.,/ (over)
DOH-1555 (02/2004)