Ferrie, Allan James /QU--
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vitalf Records BurialTransit Permit
-
Name First Middle Last Sex
Allan James Ferrie Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/26/2022 82 Years War or Dates Naval Reserve
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
✓ Circumstances Investigation
W Medical Certifier Name Title
G Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 592
Burial Date Cemetery,Crematory or Facility Name
® 11/28/2022 Pine View Crematory
Entombment Address
IICremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
N Hold Address
O
Id. Date Point of
(/) Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
f. Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/28/2022 Registrar of Vital Statistics Megan./ol:n( ctronicall:y Stgned9
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZW Date of Disposition i 2 1 i Z L. Place of Disposition nc
2 (address)
W
Cr (section) (lo(number) `'(grave number)
gName of Sexton or Person in Charge of Premise ^ L-
z (pi print)
1LJ ri7647)
Signature Title
DOH-1555(07/18)p i of 2
i ,
r - I 1.6 4 3 .-5
Public Health Law Sec. 4145(2b)
Receipt
1 Human remains of delivered on , 20 ,-
1
Pine View Cemetery Representing the funeral home named on burial,permit
•fficial Funeral Directors Reg.or License#