Petteys, Nelson NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Nelson J. Petteys Male
Date of Death Age If Veteran of U.S.Armed Forces,
Aug. 5, 1993 74 War or Dates Army WWII 1942-46
;Z Place of Death Hospital, Institution or
( j City,Town or Village Cambridge Street Address Mary McClellan Hospital
WManner of Death ® Natural Cause Accident Homicide Suicide Undetermined ❑ Pending
Circumstances Investigation
Ltd Medical Certifier Name Title
`p Rose Pecheco MD
>:: Address
S Union Street Cambridge, NY 12816
f`;; Death Certificate Filed District Number Register Number
City,Town or Village Cambridge i77 j
Date Cemetery or Crematory
❑Burial Aug. 6, 1993 Pine View Crematory
[Cremation
Address
Quaker Rd. Queensbury, NY
z Date Place Removed
o Ei Removal and/or Held
I- and/or Hold ..::
Address _: ::.... .. ..:: ...... ...::.::
cn
0 ...
a Date..... ::.:.........
................ . :..:::.. Point of..
to Transportation by
p Common Carrier Shipment
Destination
Disinterment Date Cemetery Address
ry
El Reinterment Date Cemete Address
Permit Issued to Registration Number
Name of Funeral Firm Flynn Bros. Inc. 00662
Address
80 Main Street Greenwich, NY
t-. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
�;...Address
.
Permission is hereby granted to dispose of the human
nnjremains described above as indicated.
Date Issued 8-6-93 Registrar of Vital Statistics �LZ�.-y2,_...- ?----
�D (signature)
District Number ;7�702 Place (�Ct.9y14.� s)i /Q2$/(o
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I- /
W Date of Disposition Ej `,3 Place of Disposition �j # �A t 4'2 A / �/��
2' (address)
wCA
CC (section) (lot number (grave number)
°' g D4 .. 9/t'D 4/9 777,1
p' Name of Sexton •r Person in Charge of Premises .
Z' > � (please print) �p r
Signature . Title t'/Pi��j7' �/1 1 j�
DOH-1555 (10/89) p. 1 of 2 VS-61