Hite, Donald I J310
NEW YORK STATE DEPARTMENT OF HEALT':-I - A. `1%
Vital Records Section a .,Transit Permit
Name First Middle Last Sex
( e.'v\"eL- c} #14 k% f-f r /e /t l4c t e__
Date of Death If Veteran of U.S.Armed Forces,
7 f j A O I V1/ar ar DatesU
i Place of Death Hospital, Institution
City Town or Villa e CITY OF ALBANY or Street Address 4 Al G. /1
L11. Manner of Death Natural
❑ Cause Accident Homicide ❑ Undetermined ❑ Pending
lit Suicide,. Circumstances Investigation
Medical Certifier Name Title
pe-e-1n a Ei� / !t/'c{ if ,
Address
Death Certificate Filed DistrdNumber Register Number
f City, Town or Village CITY OF ALBANY 1.01
Date Cemetery or Crematory
s ;:, ❑ Burial h _/n -//
// bt/
rvi V Ie-u� Ce-semi-,zr✓(.:
Address
Cremation /� i.)-e wS ),0u(2_ a /'t//Eycc) Ems/
Date
Pla Removed
Z Removal and/or Held
0: ❑ and/or Address
-I-- Hold
GO
o Date Point of
a. Transportation Shipment
OrY ❑ By Common
CI'' Carrier Destination
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home 4iz,Ly /J /2 /i / 7
mi Address
', D, eon -77 F� I A n ,-,. . 2 r 7
,, Name of Funeral Firm Making Disposition or to Whom
rFI Remains are Shipped, If Other than Above
LL''. Address
LLI
CL Permission is hereby granted to dispose of the human remains described.above ' dicated
Date / / r'�
Issued �` ! _�r Registrar of Vital Statistics j'. ��e? /��
(s ature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in ac ordance with this permit on:
Z Date of Disposition 1-t1"it Place of Disposition i fUIZI,J CrtieristrdriuA-
tu (address)
s (section) i-
5'*4.,.,,„.1: ;(lot number). (grave.number)
,, 7
Name of Sexton or Person in Charge'of Premises •t ii ilAntt-
z Signature ' "' Title CRLtnuA.;n�
:i , : 1 -'-t i ii 1 i '`- , i ,
+ I /' 1 0 , t 1,1= ,7
DOB7555 (9/9$j ,,, ', ;, 1,n,
,., ,i i..-; , , u.i , !4'c ,�, ,t :' /,''. >/ ,n..�� I. i;i tt ,d I u�uu7, ii WI hia iJ.x, r 1I .