Harr, Walter George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Walter George Harr Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 04, 2020 75 War or Dates 10/05/1965-10/04/1967
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address DVAMC 113 Holland Avenue Albany, NY 12208
Manner of Death®Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Vigneau, Edward MD.
Address
113 Holland Avenue Albany, NY 12208
Death Certificate Filed Alb District Number Register Number
Albany City, Town or Village y 0198 002
❑Burial Dat Wete r Crema ory
❑Entombment 1 7 D e-
Ad ss
Cremation u d
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home I Q(/
Address
1PIUA Z..
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human r m ins d scri ed ve t7ndicated.
Date Issued 1-4-2020 Registrar of Vital Statistics�i. incyt'on —
(signature)
District Number 0198 Place DVAMC, 113 Holland Avenue, Albany, New York 12208
1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1 15 10 Place of Disposition
(address)
(section) ATer3'
(grave number)
Name of Sexton or Person in Ch;�rge of Pre ses
/ (plea print)
Signature Title
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) 013219
Receipt
Human remains of ' if-' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#T— -