Meader Jr., Walter NEW YORK STATE DEPARTMENT OF HEALTH * H in3
Vital Records Section Burial - Transit Permit
Name First Middle ' Last Sex
WALTER MEADER Jg, MALE
Date of Death Age If Veteran of U.S.Armed Forces,
06/12/2018 58 War or Dates
) Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
0, Manner of Death Natural Accident Undetermined Pending
LU' ® Cause ❑ ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
O Medical Certifier Name Title
ILI
I CATHERINE PFEIFFER DO
Address
43 NEW SCOTLAND AVE ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1292
Date Cemetery or Crematory
❑ Burial 06/13/2018 PINE VIEW CEMETERY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or Address
H Hold
C
0 Dz Point of
a Transportation Shipment
V) ❑ By Common DE
El Carrier
❑ D- Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home BAKER FUNERAL HOME 01130
Address
11 LAFAYETTE ST QUEENSBURY, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
L2L'' Address
LLt.
Q- Permission is hereby granted to dispose of the human remains described ve as_ ' cated.
Date 06/05/2018 A idea/
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 accordance /with this permit on:
Z Date of Disposition G I It Iig Place of Disposition t(4' I 0f-- .
w (address)
2
Ill
N'-
CL (section) (lot number) (grave number)
0
C��' CM
Z Name of Sexton or Person in Charge of Premises J
w4 (please print)
Signature Title (PIES
(over)
DOH-1555 (02/2004)