Murphy, Thomas NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Thomas J. Mur�hv Male
Date of Death Age If Veteran of U.S. Armed Forces,
9/1.9/96 78 War or Dates Yes TATNT2
Place of Death Hospital, Institution or
City, Town or Village Glens FAlls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause Accident [:]Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Peter GravMr?
Address
90 Sout1n. St.. -lens FA_l1s,N�' 12801
>. Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 �-
Date Cemetery or Crematory
>: ❑Burial a 24 'Din- 'View Crematorium
Address
®Cremation Queens'^ury RTY
Date Place Removed
8 Removal and/or Held
•• and/or Address
Hold
Q Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home 01877
Address z fU I
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 describeo ab ve aVpdicated.
Date Issued 9/24/96 Registrar of Vital StatisticsA"e
(signature)
District Number 5601_ Place G7_ens Falls,1W
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition - ZPlace of Disposition
(address)
LU
g (sen) (lot IJi��D n mbe� � (grave number)
fl Name of Sexto or Person � Charge of Pre ises
(please print) D
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61