Darrah, Edward William Jr. NEW YORK STATE DEPARTMENT OF HEALTH tt (47
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last
Edward William Darrah Jr Sex
Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/07/2022 67 Years War or Dates
. Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 72 Feeder Dam Road, Moreau Town, New York 12803
W
Manner of Death [] []
Natural Cause []Accident Homicide Suicide Undetermined Pending
W I
U Circumstances Investigation
QW Medical Certifier Name Title
William Parker MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 45
[ ]Burial Date Cemetery,Crematory or Facility Name - -•
O8/11/2022 Pine View Crematory
[]Entombment Address
Cremation Queensbury Town, New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
Q. Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
[]Reinterment Date Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
Address
tr
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a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/11/2022 Registrar of Vital Statistics Geeann 9l4cCa6e(ECectronicaKy Signed)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l—
Z Date of Disposition ? a �a
W �J Z 2 Place of Disposition V r,JQ i�ve�,4SrtPij+? (`r(
W (a dress)
U)
O (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premiss 7 h✓ �,J� c`
Z (please print)
W Signature
Ti �L�(
DOH-1555(07/18)p t 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#