Quinn, Alfred 4 r 7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit
Vital Records Section Permit
Name First Middle Last Sex
Alfred O. Quinn Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 20, 2012 96 War or Dates World War II
1. Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 4 Kenwood Cl.
iii
es Manner of Death i XI Natural Cause Accident Homicide Suicide Undetermined Pending
ILICircumstances Investigation
ui Medical Certifier Name Title
CS John Sawyer DR.
Address
14 Manor Drive,Queensbury,NY 12804
a Death Certificate Filed District Number Regis Number
City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
II Entombment February 22, 2012 Pine View Crematorium
Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
CA
O Date Point of
NI I Transportation 1 Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
M Remains are Shipped, If Other than Above
'gh' Address
fG,
MI
Permission is hereby granted to dispose of the human re ains described atlove as indicated.
Date Issue&\Zz 0-o►d Registrar of Vital Statistics q as n.c
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition FA) G3,ZOit Place of Disposition -1'��Vcc,i o r,w...
(address)
W
Cl)
CC (section) n� s } (lot number),- (grave number)
QName of Sexton or Person in Charge of Premises ` r,si'�p 4 r• J vial-
Z 1 (please print)
W
Signature �� Title CD E 04'10,
(over)
DOH-1555(02/2004)