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Doty Jr, Volney NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Nii Name First Middle Last Sex Volnex................:....:...............:........A....:.. ..._. Doty JR.. ....: Date of Death Age If Veteran of U.S.Armed Forces, War or Dates. ..mai ::::::::....:.... Place of Death Hospital, Institution or W City Town or Village . Albany,. .::... ... Street Address DVA:.Me.idcal....center.... 1.13 olland Ave .12208 W Manner of Death ® Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ ending Circumstances Investigation W Medical Certifier Name Title © M. Astwan. MII..:..::. Address ... ........::.... .::... 1.1,.3...Ho llan.i.:.Ave..............Alb.any.h:,New...Yo.r.k"::.......... :1.2208....... .. ......:.. ..-: .:... .. .. Mii Death Certificate Filed District Number Register Number Ri City,Town or Village Albany 198 336 Date Cemetery or Crematory Burial NOVEMBER 25 1992 West Glens Falls Cemeter . ::. ❑Cremation Address z Date Place Removed O 0 Removal and/or Held t- and/or Hold :::... Address to O Date Point of co ['Transportation by Shipment p' Common Carrier Destination O Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address r Permit Issued to Registration Number Name of Funeral Firm Regan & Denny Funeral Services Inc 01602 Address 26...Quaker...Rd Queensbury, ::N.Y....::1208.4::::::........: . t- Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above irC Address Aif a: Permission is hereby granted to dispose of the huma emains describe above as ' . ated. Mi Date Issued 11 23 92 Registrar of Vital Statistics P t-Pr e ; s (signature) District Number 198 Place DVAMC ALBANY NEW YORK 12908 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition //"a?S '1oZ Place of Disposition td G F ( �,K 6'f2 ,y 1 Qci ,t/S' 6 qf2.y) AI 2 ��' (address) -�- N`tr (section) "Aij // �� (lot number) (grave number) O p Name of Sex ; or 'erson in Char e of Premises 0 4>1 G., /1/0 5 -7Z- . Z 9� (please print) LU Signature •,,�, � </' Title 5 t / 7 DOH-1555 (10/89) p. 1 of 2 VS-61