Loading...
Williford, Edmund NEW YORK STATE DEPARTMENT OF HEALTH ti q v/ Vital Records Section Burial - Transit Permit Name First Middle Last Sex EDMUND R WILLIFORD M Date of Death Age If Veteran of U.S. Armed Forces, Q— 1$-- 1) s ` i 87 War or Dates.' 43 1946 14 Place of Death Hospital, Institution or City, Town or Village Street Address Manner of Death©Natural Cause El Accident El Homicide Suicide El Undetermined Pending tj Circumstances Investigation tj tu Medical Certifier Name Title Mollie D. Shulan MD Address 113 Holland Ave, Albany, New York 12208 Death Certificate Filed District Number Register Number City, Town or Village 1 98 ❑Burial Date Cemetery or Crematory Entombment 10/04/2011 Pineview Crematory Address ©Cremation Queensbury, New York Date Place Removed Removal and/or Held ...R and/or Address E Hold CA 0 Date Point of tL 0 Transportation Shipment 6 by Common Destination Carrier Q Disinterment Date Cemetery Address `: Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Kelly Edward L Funeral Home 00519 Address Schroon Lake, New York 12870 Ni Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address #1 a ` Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 0 9/2 8/201 1 Registrar of Vital Statistics JAMES H.ARR I NGTON VSC MANAGER (signature) ><`': District Number 1 98 Place VAMC ALBANY 1 1 3 HOLLAND AVE,ALBANY NY 1 2208 # I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Ut Date of Disposition 10 L f (i Place of Disposition ?;heu ‘,6) Cr„e q tir t`vY\ a (address) Ili te CC (section)b^n) (lot number) (grave number) 0 fiz Name of Sexton or Person in Charge Premises l imp y (ro elk f-,;— % I (please print) Signature Lean T Title ef<14-‘4_ cr A5 . yai (over) DOH-1555 (02/2004)