King, Edward NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward William King Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 14, 1996 78 War or Dates WW II
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death®Natural Cause Accident Homicide F Suicide F Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Dr. James North
Address
2 Broad Street Plaza, Glens Falls, NY 12802
Death Certificate Filed Glens Falls District NurV961 Register Number
�1�City, T7RQ00 .5 a7
Date Cemetery or Crematory
❑Burial October 17, 1996 Pine View Crematorium
Address
>: U Cremation Tn of Queensbuiy, NY 12804
gDate Place Removed
Removal and/or Held
and/or Address
Hold
C Date Point of
y Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
F�Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc. 00310
Address
P.O. Box 67, 68 Main St., Hudson Falls, N.Y. 12839
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 /C� /G QE, Registrar of Vital Statistics, Z�,� �• G
(signature)
5601 Place Glens Falls, NY
District Number
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
Date of Disposition/�%�-9� Place of Disposition �,r/ .���4 c,�.r�/Y� T!/�,A(f!�
IW (address)
l;l!
(section) (lot uu er) (grave number)
10 Name of Se=Pon Charge of Premises
g (please print)
Signature Title G Q T
DOH-1555 (10/89) p. 1 of 2 VS-61