Poppe Jr., Arthur NEW YORK STATE DEPARTMENT OF HEALTHY
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arthur C. Poppe Jr. 1tla I ee
Date of Death Age If Veteran of U.S. Armed Forces,
11/15/17 71 War or Dates 1966-1970
F. Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
o Manner of Death x Natural Cause Accident Homicide Suicide ' Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
ti Scott Beegle MD Sathya Velkuru DO
Address
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0/0/ B 9
❑Burial Date Cemetery or Crematory
11/16/17 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury, NY
Date Place Removed
Z 1 I Removal , and/or Held
O and/or Address
H Hold
N
O Date Point of
O.
u) Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L.Kelly Funeral Home 00519
Address
Schroon Lake, New York 12870
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
W
O.
Permission is hereby granted to dispose of the human rema" s described above as indicated.
Date Issued /1/S/aoi 7 Registrar of Vital Statistics xx.ce..14 ��
atu )
District Number o,' ,, Place a:% a/ Ath
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
gDate of Disposition fl /2.0 10 Place of Disposition g tj-. ',�..'
W (address)
co
p0 (section) lot number) (grave number)
Name of Sexton or Person in Charge of Premises t,,+ S4"i�j`
z
illZ (ple a print)
Signature - 4) Title 8;1400T°
(over)
DOH-1555 (02/2004)