Smith, Arthur NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Arthur M. Smith male
-..,i,......
Date of Death ? Age If Veteran of U.S.Armed Forces,
October 25, 1991 72 War or Dates World War II
t Place of Death Hospital, Institution or
jai City,Town or Viligd.ty of Albany Street Address Albany Medical Center
..
C) Manner of Death Undetermined D Pending
El Natural Cause D Accident 0 Homicide 0 Suicide El
ILI Circumstances Investigation
Medical Certifier Name Title
1,14
M. Kurian MD
Address
Albany Medical Center Hospital, Albany, N. Y.
Death Certificate Filed District Number Register Number
.,....: City,Town or Village City of Albany 1 01 2181
Date Cemetery or Crematory
in Burial October 28, 1991 Pine View Cemetery
. .... . .. . . .... .
0 Cremation Address
Queensbury, New York
Z Date Place Removed
0 0 Removal and/or Held
i— Address
u)
0- Date Point of
u) El Transportation by
Shipment
p Common Carrier
Destination
. .
Date Cemetery Address
O Disinterment
Date Cemetery Address
O Reinterment
Permit Issued to Registration Number
......
Name of Funeral Firm Regan and Denny, Inc. , 01602
.,. Address
26 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
... .:
2 Remains are Shipped, If Other than Above
. ..
Address
1JJ.
...... Permission is hereby granted to dispose of the human remains described abo e as indicated.
Date Issued Oct. 28, 1 9 91
Registrar of Vital Statistics C,
(signature)
..: .
:...
District Number 10 1 Place a14Cv» )1 1,
I
I certify that the remains of the decedent identified above were disposed of in accordance4ith this ptimit on:
.....
7
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Cr (section) (lot number) (gravenumber)
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p Name of Sexton erson in Charge of Premises / ,,,z,.),--, / c___-_, _ ,/-7.,, 3 g-,-/-•,._,
z (please print)/
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Signature r , A..1,/,......----- Title
DOH-1555 (10/89) p. 1 of 2 VS-61