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Morrison, Thomas George �N EW YORK STATE DEPARTMENT OF HEALTH (1 3s� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas George Morrison Male Date of Death Age If Veteran of U.S.Armed Forces, 04/17/2023 68 Years War or Dates i_ Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address 1 Mauro Avenue,Glens Falls,New York 12801 p Manner of Death I I Natural Cause nAccident n Homicide nSuicide (Undetermined ❑Pending I I I 'Circumstances Investigation WMedical Certifier Name Title CI 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 203 Burial Date Cemetery,Crematory or Facility Name 04/19/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York JDonation 0 Lni i Removal Date Place Removed and/or and/or Held f- Hold Address N 0 O. Date Point of U)Dransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El 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 1— Remains are Shipped,If Other than Above 2 Address Q uJ a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/18/2023 Registrar of Vital Statistics Megan Aroln(EkctronicalySigned) (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: I— • � Z Date of Disposition zls 7.23 Place of Disposition rI lJe t4 '„J Crc,�,l�4 2 (address) W N Cr (section) (lot number) (grave number) gName of Sexton or Person in Charge f Pre iseAS✓/�11.� �� Z (please print) W Signature Title D {'_"—?t: DOH-1555(o7/18)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#