Alkes, Isaac NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• f Name First Middle Last Sex
}• 0 Isaac Alkes Male
Date of Death Age If Veteran of U.S. Armed Forces,
t% February 3, 2013 94 War or Dates World War II
f Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Ti Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
%'. Medical Certifier Name Title
F. Scott Biasetti Dr
"' Address
100 Park St.,Glens Falls,NY 12801
r Death Certificate Filed District Number Regi;teLNumber
;,i City, Town or Village Glens Falls 5601 `/"11(�
0 Burial Date Cemetery or Crematory
February 5, 2013 Shaaray Tefila
❑Entombment Address
0 Cremation Media Drive, Queensbury, NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
.' Hold
Cl)
O Date Point of
NU Transportation Shipment
'p by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Stafford Funeral Home 01443
`' Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
5
Permission is hereby granted to dispose of the human remains described above as indicated.
',..N Date Issued 2 /y/ /3 Registrar of Vital Statistics W W
• ` (sign re)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
tu \1 Date of Dispositiortj' ' Place of Disposition �cur(�.�G� (�( (�'��j
(address)
W
U)
CL (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises
Z (please print)
W Signature —^( '' Title (y J c_C.. .d`J(e. r_
(over)
DOH-1555(02/2004)