Scheidegger, Michael .Aril
ft 2/0
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Michael William Scheidegger Male
Date of Death Age If Veteran of U.S. Armed Forces,
4/13/2016 45 War or Dates 04/04/1989 TO 08/18/1992
Place of Death Albany, NY Hospital, Institution or
City, Town or Village Street Address Stratton VAMC 113 Holland Ave,Albany,NY 12208
Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined 0 Pending
Circumstances Investigation
Medical Certifier Name Title
Jared Campbell ND
Address
VAMC 113 Holland Ave,Albany NY 12208
Death Certificate Filed Albany, NY District Number Register Number
City, Town or Village 0198 043
El Burial Dat� ( � � �( 6 Ceme or Crematory� c� e� ���19.4 c-,
['Entombment I Address_
'4 Cremation '1 07 ifZ.etel.d,..) )) 11 f
Date Place Refhdved
El Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
El Disinterment
Date Cemetery Address
Q Reinterment
Date Cemetery Address
Permit Issued to ` Registration Number
Name of Funeral Home ( 11C C1) {ut. f 4t►v6 043
Address
t4 M r\) Si IWO 0 FA/u- ri Rsr37
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
3F
Address
Permission is hereby granted to dispose of the human re a pis describe, . % • e�as-�i►� is�:
Date Issued 4-13-2016 Registrar of Vital Statistic s�H_�' 'me cn 4 6/
(signature)
District Number 198 Place VAMC,113 Holland Ave.,Albany,NY 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition q Ilcfl'6 Place of Disposition /f:4 IL, C h-.
(address)
(section) 17 . (lot number (grave number)
Name of Sexton or Person in Charge of Premises ari.erl% /
please print)
Signature a �`4}4 TitleTk-
(over)
DOH-1555 (02/2004)