Albert, Henry NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex
Henry L. Albert male
Date of Death Age If Veteran of U.S. Armed Forces,
October 7, 1998 86 War or Dates WWII
F Place of Death Hospital, Institution or
City, XR X-X4QEC ( Glens Falls Street Address Glens Falls Hospital I.
14
Manner of Death ❑X Natural Cause ❑Accident El Homicide 0 Suicide EUndetermined ri Pending
ittj Circumstances Investigation
lia Medical Certifier Name Title
O Thoams Coppens, MD
Address
iN 3 Irong_ate Centre, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
ini City, RAXMXIONVOMX Glens Falls 5601 '
Date Cemetery or Crematory
E1 Burial October 9, 1998 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
0❑Removal and/or Held
r2 and/or Address
Hold
0 Date Point of
N❑Transportation Shipment
C by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address •
Permit Issued to Registration Number
Name of Funeral Home i��o'er`, f1 / ti Q/ rJ`
Address �7
,,..
Name of Funeral Firm Making Disposition or to Whom j
Remains are Shipped, If Other than Above
Address
U
Q
Permission is hereby granted to d ep Aso of tEr.; human remains deocribec above as halos' a
Date Issued 1elOr Registrar of Vital Statistics C/t -
��yy� ��jj��
District Number Place _��`--4-4-d ,,,c,t(sti,3nature)
, /)7 - /3-F0 7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
IDate of Disposition 10/9/9 8_ Place of DispositionP i n e View Cemetery , Queensbury , NY
2 (address)
Incn Hudson #3 16-B 4
CC (section) (lot number) (grave number)
GName of Se or Person in Charge of Premises B ad n P y G . M n s h e r
g (please print)
W Signature . v-- Title ,Superintendent
DOH-1555 (10/89) p. 1 of 2 VS-61