Terry, Walter NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
ie Name First Middle Last Sex
Walter J. . Terry Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 6, 1999 84 War or Dates US NAvy
: Place of Death Hospital, institution or •
FL-vCity, Town or Village Queensbury, NY Street Address Westmount Health Facility
In Manner of Death r(XI Natural Cause El Accident n Homicide n Suicide ❑Undetermined I I Pending
;LU Circumstances Investigation
W• Medical Certifier Name Title
Richard Spitzer, MD
Address
55 Sheridan Ave. GF, NY 12801
Death Certificate Filed District Number Register Number
fiii City, Town or Village Queensbury, NY 5657 i GP/
Date Cemetery or Crematory
Pine View Cemetery
Burial May 10, 1999
Address
LJ Cremation Quaker Rd Queensbury, NY
Date I Place Removed
0 Removal Land/or Held
�- and/or Address
Hold
Q Date ' Point of
Li Transportation I Shipment
0 by Common Destination
Carrier
0 Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
ini Permit Issued to ' Registration Number
Name of Funeral Home Singleton-Healy Funeral HOme 01773
Address
407 Bay Rd Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
° Address
W
t
Permission is hereby granted to dispose of the human rem ms descri' c)'ab, ve as indicated.
iiimi
mi Date Issued 5/10/99 Registrar of Vital Statistics C,
gnature)
District Number 5657 Place Town of Queensbury, NY 1 804
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition5[ 10/99 Place of Disposition Pine View Cemetery , Queensbury , NY
2 (address)
UJ Unadilla Ext . 8-B 2
EC (section) (lot number) (grave number)
gName of Sexto erson in Charge of Premises Rodney. G . Moshe r
z (please print)
W Signature -16 . "21.0- �,,L Title Superintendent
DOH-1555 (10/89) p. 1 of 2 VS-61