Winchip, Arthur F 1! 3Db
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section .
i
Name First Middle Last Sex
ARTHUR PAUL WINCHIP MALE
Date of Death Age If Veteran of U.S.Armed Forces;-
4/15/2018 83 War or Dates
Place of Death Hospital, Institution
City,Town or Village ALBANY or Street Address ,, ALBANY, MEDICAL CENTER
litcf Manner of Death Natural ❑ Undetermined ❑ Pending
LU ® Cause Accident ❑ Homicide ❑ Suicide
Circumstances Investigation Accident
Medical Certifier Name Title
lit•a ANITA MALLYA MD
Address
AMCH 43 NEW SCOTLAND AVE., ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village ALBANY .)101 0842
Date Cemetery Or Crematory
El Burial 4/16/2018 PINE VIEW CREMATORIUM
0 Entombment Address
®Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
I- Hold
U)
0f
Transportation Date Point Shipment
CO ❑ By Common
Carrier Destination
ElDate Cemetery Address
Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home BARTON-MCDERMOTT FUNERAL HOME INC. 00141
Address
9 PINE STREET, CHESTERTOWN, NY 12817
}- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
11 Address
W....."......
Permission is hereby granted to dispose of the human remains described ab as indi
Date 4/16/2018 Registrar of Vital Statistics
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordancei with this permit on:
Date of Disposition twinPlace of Disposition _ V—... (p 10.......
MI (address)
Es
to
d?
C (section) (lot umber) (grave number)
0
0
w � }p� j...1
Name of Sexton or Person in Charge of Premises ,,, tl:i}'
(please print) r
Signature 8 ��� Title reErtA Ilk
(over)
DOH-1555 (02/2004)