Morse, Morton ( ) q
I
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Morton W. Morse Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 2,2012 83 War or Dates - -
Place of Death Hospital, InstitutiorW cam` ' i-County Health Care
Z City, Town or Village Johnsburg Street Address ter
p Manner of Death I XI Natural Cause Accident Homicide I Su Una ,ermined Pending
tv Cir istances Investigation
W Medical Certifier Name -Tine
G Dr.James Hicks,MD
Address
1 IHN,North Creek,NY 12853
Death Certificate Filed District Number Regi ter umber
City, Town or Village Johnsburg 5655
❑Burial Date Cemetery or Crematory
Entombment Address
3,2012 Pine View Crematory
Address
El Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
i' Hold
U)
O Date Point of
Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped, If Other than Above
2 Address
W
a
Permission is hereby granted to dispose of the human remain des ribed ab� as indicated.
Date Issued 7 /(96 t a2Registrar of Vital Statistics jL� e
/ (signature)
District Number 5655 Place Johnsburg
F-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition -1 i c Place of Disposition rcv Lrw C n1rt0FfV ...
2 (address)
N
(section) // (lot number) S (grave number)
Z Name of Sexton or Person in Charge Premises [hoer eq,
(phrase print)
W Title eta*haAlrt Ift7i'Xl
(over)
DOH-1555 (02/2004)