Winchell Jr., Walter NEW YORK-STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex
Walter J. Winchell,Jr. 1 _ Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 9, 2011 1 45 War or Dates
: Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 82 Alpine Ave
pManner of Death I I Natural Cause I I Accident Homicide Suicide Undetermined x Pending
115 Circumstances Investigation
w Medical Certifier Name Title
0 Timothy Murphy Coroner
Address
52 Haviland Ave. Glens Falls,NY
Death Certificate Filed j D c N bn 1 Register Number
City, Town or Village Queensbury ( 0
❑x Burial 1 Date Cemetery or Crematory
May 13, 2011 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
i Hold
CD
0 Date Point of
yTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to 1 Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury, NY 12804
-' Name of Funeral Firm Making Disposition or to Whom
t, , Remains are Shipped, If Other than Above
5 Address
Ce
di
Permission is hereby granted to dispose of the human e ins described above as indicated.
Date Issued 1(-)-1 e-)..C) (, Registrar of Vital Statistics �ma� `/�'l / t
(signature)
District Numbet(0 'Th Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 5/13/11 Place of Disposition Pine View Cemetery
2 (address)
w N Seneca 18D 1
rt (section) (lot number) (grave number)
in Name of Sexton or Person in Charge of Premises Michael Genier
W ,1�'V`µ - (please print)
Signature Title Superintendent
(over)
DOH-1555(02/2004)