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Morgan, Jean R.
....... LF: ,1 Z A NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jean R.Morgan Female Date of Death Age If Veteran of U.S.Armed Forces, 03/19/2023 89 Years War or Dates 1957-1962 F— Place of Death Hospital,Institution or WZ City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death 0 Natural Cause Accident ❑Homicide Suicide Undetermined Pending W I—I U Circumstances Investigation W Medical Certifier Name Title C John Quaresima MD Address 319 Broadway,Fort Edward Town,New York 12828 DeaEth Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 31 Burial Date Cemetery,Crematory or Facility Name 03/21/2023 PineView Crematory Entombment Address�"` ©Cremation r Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F— Hold Address N 0 a Date Point of (Q❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment 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 CC W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/20/2023 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition .z)ZI 113 Place of Disposition -�(L �—� (address) W V/ (section) (lot number/ (grave number) CC - r-t G Name of Sexton or Person in Charge. f Premises • �(�je�aseprint) Z 4\r/0 µ i W Signature Title DOH-1555(07/18)p 1 of 2 G.' " 7 m{{� F 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#