Hopkins, Marshall NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marshall E. Hopkins male
Date of Death Age If Veteran of U.S. Armed Forces,
nuar 3 1 998 51 War or Dates Vietnam
Place of Death Hospital, Institution or
ff kT:RWW5tQrVillage Greenwich Street Address 18 John St.
Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Joseph C. Mihindukulasuriya, MD
Address
Glens Falls, NY
Death Certificate Filed District Number Register Number
Rr Ar Village Greenwich 5722 1
Date Cemetery or Crematory
El Burial January 7, 1998 Pine View Crematory
n Address
LICremation Queensbury, NY
Date Place Removed
Z ❑Removal and/or Held
and/or Address
Hold
Q Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Flynn Bros. , Inc. 00665
Address
80 Main St. , Greenwich, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as
indicated.
Date Issued 1 /7/9 8 Registrar of Vital Statistics — ,►e. Q �2x.�.�/
s
(signature)
District Number 5722 Place Village of Greenwich, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
g LU Date of Disposition of Disposition
(address)
41
X (section) (lot nu mbe�j ,Q (grave number)
GName of Sexto or Person in Charge f Premises �n, , I 149
F (please print) � /�---
Signature Titlejfgw
DOH-1555 (10/89) p. 1 of 2 VS-61