Milligan, Donald 3
NEW YORK STATE DEPARTMENT OF HEALTH E --. ! Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
DONALD L MILLIGAN MALE
Date of Death Age If Veteran of U.S.Armed Forces,
08/08/2011 89 War or Dates 1941-1945
I— Place of Death Hospital, Institution
W City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
p Manner of Death Natural El
❑ Pending
® ❑ Accident ❑ Homicide ❑ Suicide
W Cause Circumstances Investigation
W Medical Certifier Name Title
o SAYED TARIQ MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1471
Date Cemetery or Crematory
❑ Burial 08/09/2011 PINEVIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or Address
H'- Hold
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Date Point of
i. Transportation Shipment
CO ❑ By Common
0 Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home EDWARD L. KELLY F.H. 00519
Address
SCHROON LAKE, NY 12870
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
re
W'
11. Permission is hereby granted to dispose of the human remains de ribed above as indicated.
Date 08/09/2011 e - k 4L_Q.'�`e..
Issued Registrar of Vital Statistics - 3ur `�
(signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition g it)- (( Place of Disposition 'Pi y1e theLJ CC &4 .9 f i%1 wt
w (address)
w
en
W'-_ (section) (lot number) (grave number)
Ct
Z Name of Sexton or Person in Charge of Premises mA vye(lc
W
(please print)
Signature Title ct'rvr,c. xtry 1A'5 -.-
/ (over)
DOH-1555 (02/2004)