Lang, Eric EW YORK STATE CEPARTMENT OF H�TRS . s \
l Recoils Burial - Transit Permit
Name Fast
Lao
MALE
If vee ,n of U S. Armed Forme
1 0l 1 ! 16 49 Wei or feared
Place of Death
HoCiter __.
. _. ► af 'tban�'...n._ ar Skedi ST PET R HOSE INN
of Death kitttn ,�a,___
C� El Acossfs C �to¢e ❑ sut ❑
mtiried
,,-). Medical Certifier
bee
ate .__. �._
_
Jtw1t PAtRSt _� FNP
dress
315 S MANNING BLVD..ALB NY NY 12208
Dragnet Number
r. City.'TOM or Vane City of Albany 101 21�d
�..
Cemeteryi Date or Crienvaaty
El Banal i Erb 1 a16 PyNV14'K CFtEMATORY
Env > .
Address
rer uektdn QUEENSBURY, NY
Dere Place Hemmed
Z Removal ndror Held
�n
g [114Yi I _ u Address
t#nk!
Transportati Shipment
0 By Common _ ___s____ ,. ,_._T_m_.,_
l
Camel'
esiintr
Oi9nreerment
Daler Cemetery areas_.._._. ._
El tiagrnttirrrrr Dates Camelot,/
1
Permit taste To a Rewisessee Nur ber
Name of Furerar Home ALEXANDER BAKER FM I ON)37
Adtkess
3809 MAIN ST WARRENSBURG NY 12885
Name of funeral Foam Making D spOS4110r%or to Whom
—4 Romaine ate Strippezt,if Draw than Above
Adtireie
t4
ett�ipstan�a here granted to dispose of tele human remains de alt abovese fifliceis d-
1�11201 E3 ti .'' f ....t
„°
..�r 1�4giatrer d 1/�a!Stitli(�
tt tur l ia
Issued
tlistr�t Nt 101 p ce City of Albany NY ___..
I certify that tho tonne*of ter deonclerti KI+rYl feed rye emirs drnOcrsed or In ar-Pantince with this t en
-P ,
Dote of C>, ^
JP I2`1111' Ptaca ti sii ntw..t
Itdnest
Ti
raura
3 rs 3�r�
Nam of Sergi of Person in Charge of Premises
(porase pan!)
(4.$
Signature
. a.:.4
DOWI$65(O2120041