Berman, Morton NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Morton Berman Male
>` Date of Death Age If Veteran of U.S. Armed Forces,
September 1 1 , 1996 83 War or Dates No
Place of Death Hospital, Institution or
City, Town or Village Queensbury, N.Y. Street Address 31 Hicks Road
Manner of Death Fx Natural Cause n Accident n Homicide Suicide Undetermined Pending
_ Circumstances Investigation
Medical Certifier Name Title
William Tedesco MD
Address
17 Pine Street Glens Falls, New York 12801
Death Certificate Filed District Number RegiAerr\Number
City, Town or Village Queensbury, N.Y. 5657
Date Cemetery or Crematory
[]Burial September 13, 1996 Pine View Crematory Quaker Road Queensbury, N.
Address
®Cremation Quaker Road Queensbury, New York 12804
Date Place Removed
Z❑Removal and/or Held
and/or Address
M Hold
Q Date Point of
NQ Transportation Shipment
0 by Common Destination
Carrier _
[]Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Horne Singleton-Healy Funeral Home Inc. 01807
Address -
407 Bay Road Glens Falls, New York 12801
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 hums a ins d scneove indicated.
Date Issued Sept. 13, 1996Registrar of Vital Statisti s
(sign ture)
District Number 5657 Place O»PPnshnrV, New yark 198n4
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f
W Date of Disposition ' �� Place of Dispositiongj4e- �,C�- Ak&-ag
.2 (address)
LU
E 9 (,section)., (IQt number �� (grave number)
AName of Sextor r Perso m Charge of P rnisesY� �s
z lease print)
W Signature Title ,' r
DOH-1555 (10/89) p. 1 of 2 VS-61