Willigan Jr., Edward t --1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
>=_ Name First Middle Last - Sex
Edward Bernard Milligan, Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/16/2012 71 War or Dates No
i Place of Death 'Hospital, Institution or Community Hospice of Albany
City,Town or Village City of Albanyilf. Street Address at St. Peter's Hospital
a Manner of Death®Natural Cause ❑Accident D Homicide 0 Suicide ❑Undetermined �Pending
111
Circumstances Investigation
Medical Certifier Name Title
q John E. Caracandas M.D.
<+ Address
400 Patroon Creek Blvd., Albany, NY 12206
:. Death Certificate Filed District Number Register Number
' 3 City,Town or Village City of Albany 0101 j R 1
®Burial Date Cemetery or Crematory
< ., 11/20/2012 Pine View Cemetery
..i❑Entombment Address
1 OCremation Queenabury, New York
JM Date Place Removed
E DRemoval and/or Held
for Address
Hold
Date Point of
0 Transportation Shipment
fl by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
14 Date Cemetery Address
s Reintemrent
>-' Permit Issued to [ Registration Number
i%t Name of Funeral Home Maynard D. Baker Funeral Home I 01130
Address
11 Lafayette Street, Queensbury, NY 12804
=< Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tC
Ia-
f" Permission is hereby granted to dispose of the human remains described as indicated.
iN Date issued 11/19/2012 Registrar of Vital Statistics
_< District Number 0101 Place City of Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1 1 -2 0-1 2 Placeof Disposition Pine View Cemetery
X (address)
80 Erie 79 A 1
EL (section) (lot number) (grave number)
pp Name of Sexton or Pers ' Charge of Premises •. Michael Genier
Z (please print)-
Signature `J Title Superintendent
(over)
DOH-1555 (02/2004)