Morris, Jr. Delos NEW YORK STATE DEPARTMENT OF HEALTH. ° - * r! 53
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Delos Edwin Morris,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 27,2012 80 War or Dates 1951-1955
F;,° Place of Death Hospital, Institution or
Z City, Town or Village Albany Street Address Albany Medical Center Hospital
Wp Manner of Death Natural Cause Accident 1 I Homicide Suicide Undetermined Pending
W Circumstances Investigation
w Medical Certifier Name Title
CI Kevin M.Jones,MD
Address
'_ AMCH 43 New Scotland Avenue,Albany,NY 12208
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 0101 /,9(L S'
❑Burial Date Cemetery or Crematory
❑Entombment June 29,2012 Pineview Crematorium
Address
x❑Cremation Queensbury, NY _
Date 1 Place Removed
Z 1 I Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
LJ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home,Inc. 00281
Address
68 Main Street,PO Box 67,Hudson Falls,NY 12839
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
• Address
CL
fZ Permission is hereby granted to dispose of the human remains described above as indicated. ,
Date Issued 1•,/'e//O a Registrar of Vital Statistics ii," a Q . tQ�
30.) (signat )
District Number 0101 Place City of Albany V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ')r2(a. Place of Disposition i iy40tdW �li7lot(o ...
W (address)
N
CL
(section) of number) (grave number)
p• Name of Sexton or Person in Charge o Premises /1:
a* Jehaft
4
Z (please print)
La
Signature Title ME.I')&1 Ot-
(over)
DOH-1555 (02/2004)