Lindheimer, Clarence ittil
NEW YORK STATE DEPARTMENT OF HEALTH t Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
CLARENCE T. LINDHEIMER MALE
`' Date of Death Age If Veteran of U.S.Armed Forces,
06/11/2015 68 War br Dates NO
fo. Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER l _
tt Manner of Death Natural Undetermined Pendin9
® ❑ Accident ❑ Homicide ❑ Suicide
IJJ Cause ❑ Circumstances ❑ Investigation
• " Medical Certifier Name Title
ILI
CI MEDAROV BORIS MD
Address
43 NEW SCOTTLAND AVE ALBANY, NY 12208
Death Certificate Filed District Number Register Number
• City,Town or Village City of Albany 101 1244
Date Cemetery or Crematory
❑ Burial 06/15/2015 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q', 0 and/or Address
I_ Hold
CO
Date Point of
CL Transportation Shipment
N 0 By Common Destination
Ct Carrier
❑ Date Cemetery Address
Disinterment
0 Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home M.B. KILMER FUNERAL HOME 01077
• Address
A, 123 MAINSTORRE ARGYLE, NY 12809
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
te
UI
u• Permission is hereby granted to dispose of the human remains descr'•-• above as indicated. 2
Date 06/11/2015 Registrar of Vital Statistics �- -�` c= ` k(I' 17_
62
Issued ature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance�I with this permit on:
Z Date of Disposition (0Ii11(r Place of Disposition .rp4/U.,,: Cato+—
D (address)
W'
co)
W (section) (lot number) (grave number)
0 /if
Z' Name of Sexton or Person in Charge of Premises G""-'�� —CL./Al*
(please print)
f k
Signature X
Title fl14 P�
(over)
DOH-1555 (02/2004)