Weeks, Edgar William if
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edgar William Weeks Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/01/2023 74 Years War or Dates 71-74
f.. Place of Death Hospital,Institution or
W City,Town or Village Schaghticoke Town Street Address Diamond Hill Nursing And Rehabilitation Center
p Manner of Death Natural Cause Accident Homicide ESuicide nUndetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Mikram Jafri MD
Address
100 New Turnpike Rd,Schaghticoke Town,New York 12182
Death Certificate Filed Town Of Schaghticoke District Number Register Number
City,Town or Village 4161 1
RBurial Date Cemetery,Crematory or Facility Name
01/03/2023 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
DDonation
0❑Removal Date Place Removed
and/or and/or Held
NRHold Address
Date Point of
N Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
' 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
H Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2023 Registrar of Vital Statistics Jennifer lf Mo(esky(ECectronicaCCySigned)
(signature)
District Number 4161 Place Town Of Schaghticoke
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z -� /�
W Date of Disposition /^�0'1.1J13 Place of Disposition Pi Am 0 e' ,1 L r t
(address)
W
M (section) (lot number) (grave number)
0 Name of Sexton or Person in C rge of Pr ises t�fi �'4 ''✓ UD(please print
Z
W Signature Title e f erx vC
DOH-1555(07/18)pi of 2
fly a 7 L-„'
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#