Ward, Alfred NEW YORK STATE DEPARTMENT OF HEALTH:'
Vital Records Section Y ; - Burial - Transit Permit
Name First , Middle Last Sex
Alfred E. Ward Male
Date of Death ----Attell. If Ve an of U.S.Armed Forces,
11/26/201g r or Dates 1958-1960
i Place of Death Hospital, Institution or
-
Z City, Town9LV11tage Saratoga Street Address Home Of The Good Shepard
Wp Manner of Death ,3 fl Natural Cause n Accident n Homicide ❑Suicide n Undetermined ❑Pending
W �/l Circumstances Investigation
W' Medical Certifier Name ( Title
CI (M ,S
t i a te-
Address
Se'5Z6 / ti7"2 Se--) cccij2i d .A S `�''/V S'. -
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs,NY ay( co Z
❑Burial Date Cemetery or Crematory
November 29,2018 P= ;View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road,Queensbury,NY 128'
Date Place Removed
Z Removal and/or Held •
and/or Address
H Hold
N
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
2 Address
CZ
W'
a Permission is hereby granted to dispose of the human re • oste‘digt s Indic ed.
Date Issued 11 12- 1 1 1 e, Registrar of Vital Statistics
(signature)
District Number LI 5-0 I Place S&v-ee- q or SP ri rr 1 S i N I.(
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1/—, o-'' Place of Disposition p;,„e, V;e,y, Cr.ejry q,V
W I i/ (address)
U)
Ct
0 (section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises TR-i,Pr1'0/ 2),A;/'2,5
'Z (p ease print)
Signature Title c,l'-e,im 1-1-or
7 (over)
DOH-1555(02/2004)