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Hurd, Orrin R NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex ... _:.::::: ........Male.............. Date of Death Age If Veteran of U.S.Armed Forces, Jan.::1.5..,1992 : ...............:: _76:... War or Dates Yes WWII ........ .........._. F- ... Place of Death Hospital, Institution or W, City,Town or VillageGlens Falls, NY Street Address Glens Falls Hospital ::: _ :..: . ................ Manner of Death �atural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation U ........ ....... ..... ..... .. .... Medical Certifier Name Title © William St John MD.... .............. .. .......... ..::::::. .::::::::.. -.:._:::.... : . .: ..::. Address 464 Glen Rd Glens Falls, NY ..., ........ Death Certificate Filed District Number Register Nu er City,Town or Village Glens Falls 5601 Date Cemetery or Crematory ❑Burial Jan l7, 1992 _..... Pn2::View_Crematory .. ............ ®;Cremation Address . . Quaker Rd Queensbury, NY_12804 Z Date Place Removed 2 ❑ Removal and/or Held F- and/or Hold ::::... ..-....... . ..:::::......_.... ..... ..... Address N 0....-::. .::::::.. .: :...... ......... a Date Point of N ❑Transportation by:: Shipment p Common Carrier .......................... .:::.... ._.:::. .: ........... :__:. ........ ._ ... Destination -:::.:.. .... . ........ ....::......: -. .,.... Disinterment Date Cemetery Address .........: Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Firm James F. Singleton Funeral Home, Inc 01.825 ....... .... ... .. .......... Address 314 Bay Rd Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above . ..._..:: : .:::............:.:..:.. .. ....... .:..... ....... ......................�..... .:::..: . ._::::::: .... _......... Address tu> .. Permission is hereby granted to dispose of the huma emains des ribed above as indicated. Date Issued ,Tan 17, 19g2 Registrar of Vital Statistics (signature) District Number 5601 Place Glens Falls, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ^/ Z Date of Disposition��'L—� Place of Disposition 2 (address) W N` (lot number) (section) J (grave number) cc p Name of Sexton o Person in har a of Premi s se print) �—W', Signature �- Titles DOH-1555 (10/89) p. 1 of 2 VS-61