Padowicz, William 11/23/2015 14:47 15184895632 •. TEBBUTT FREDERICK PAGE 81
# SZ7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
w
`' Name First Middle Last Sex
l William J. Padowicz Male
j' Date of Death Age If Veteran of U.S.Armed Forces,
11/20/2015 62 War or Dates No
i—' Place of Death Hospital, Institution
Z. City, Town or Village City of Albany or Street Address Albany Medical Center
til
Manner of Death Natural Undetermined Pending
a ® ❑ Accident ElHomicide ❑ Suicide ❑ ❑
Investigation
s: Medical Certifier Name Title
p`;_ Joel Bartfield MD
Address
43 New Scotland Ave. Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 2414
Date Cemetery or Crematory
❑ Burial 11/23/2015 Pine View Crematorium
❑ Entombment Address
CZ Cremation Queensbury, NY
Date Place Removed
Z ❑ Removal and/or Held
and/or Address
F_ Hold
Date Point of
a Transportation Shipment
(„O ❑ By Common ..__.Mr..
Destination
Q Carrier
ElDate V Cemetery Address
Disinterment
Date Cemetery Address
❑ .Renterment
Permit Issued To _ Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd. Queensbury, NY 12084
•
MName of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ZAddress __._
II^Permission is hereby granted to dispose of the human re t»ai scribed above as indica d.
Date 11/23/2015 . i
Issued Registrar of Statistics ure)
i '
HDistrict Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordanceL L with this permit on;
I. Date of Disposition 1I/ZK/ir Place of Disposition a cc 1L 6+ .0
W (address)
W
(I
cc (section) (lot number) (grave number)
p
Z Name of Sexton or Person in Charge of Premises Atti 4-Cl40,01-
W' (please print)
/ iTitle_Signature Q
(over)
DOH-1555(02/2004)