Morrissey Jr, Michael NEW YORK STATE DEPARTMENT OF HEALTH 1# ID
Vital Records Section Burial - Transit Permit
Name First G, Middle, Last Sex
Inc 1 Fe1 r/ S se r a_l,e
Date of Death / Age If Veteran of U.S.Armed orces,
/ s - / 5" 5-Z. War or Dates
I- Place of Death Hospital, Institution
i City,Town or Village City of Albany or Street Address I bcA.,14 114 ,ziA Cza.-i
Manner of Death Natural Unytermined Pendin
Cause ❑ Accident ElHomicide ❑ Suicide ❑ ❑ g
Circumstances Investigation
II~t' Medical Certifier Name ' Title
fa P� u.�5 o, ko.v , Doer
` , n Address
I.00/16-•••--D., 7 A v /2ZV e
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101
Date Cemetery or Crematory / �p� �)
❑ Burial j-- �Q / i/ / A V e W
Address /I ; fid
` 6(-?-ry /j Jix
Cremation 2 ( UC l A Rf2,i a ueei �S /Date Place Removed
Z Removal and/or Held
0 ❑ and/or F Hold Address
G
U Date Point of
11. Shipment
N ❑ By Common 0 Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Renterment
Permit Issued To Registration Number
Name of Funeral Home (49--ryi /U�, r ,ve C re 66j‘y
Address
402 le 14- S S / tee GG
Name of Funeral Firm Making Disposition to Whom
F Remains are Shipped, If Other than Above
S Address
U' _
Lk- Permission is hereby granted to dispose of the human remains described above as indicated.
Daued r 1/ 2 / C r Registrar of Vital 9€etrst�t T —. ..
Is (signs re)
District Number 101 Place Albany Police ent 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 I/10)1S Place of Disposition 'tU (V� avrne.,7tof.,.-
tu (address)
Wre
'J
en
0 (section) (lot nu er) (grave number)
CI
W
Z Name of Sexton or Person in Charge of Premises (ts-8d)1�- J'moil-
(please print)
Signature 4 Title alE mat
(over)
DOH-1555(9/98)