Loading...
Morgan, Scott Howell 4 "5- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Scott Howell Morgan Male Date of Death Age If Veteran of U.S.Armed Forces, 01/21/2022 68 Years War or Dates • Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital aManner of Death ©Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation • Medical Certifier Name Title Thomas Kandora MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 66 Burial Date Cemetery,Crematory or Facility Name 01/27/2022 Pine View Crematory Entombment Address 0 Cremation Queensbury,New York ❑Donation Z Removal Date Place Removed and/or and/or Held Hold Address N 0 tZ Date Point of V) ❑Transportation S by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Cremation Society of Chittenden County Address 261 Shelburne Road,Burlington,Vermont 05401 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped,If Other than Above Address CC W ▪ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/27/2022 Registrar of Vital Statistics Megan No/in(ECectronicaCCy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tDate of Disposition j /7 '(ZZ Place of Disposition V (address) tU Q (section) (lot number) (grave number) Name of Sexton or Person in Charge of Prem. es AArr► (pie e print) W Signature Title cTA I '� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#