Lemelin Sr, Bruce Vital Records Section
- - a r. r t p..Burial - Transit Permit'10
Name First Middle Last Sex
Bruce. G Le meIJn SA . �'
Date of Death Age If Veteran of U.S.Armed Forces,
21 _ 2 0 !j War or Dates ��
�. Place of Death Hospital,Institution Ail
( i C -
City ,Town or Village City of Albany or Street,Address , a Yl�% f v GZ C1
�` h
I Manner of Death 6D Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ U determined ❑ Pending
'111Cause Circumstances Investigation
Medical Certifie�, Name n , e } Title
h e • N
Address
. AibcLj , i'v)/
g Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101
CI Burial
Cemetery or Crematory
Burial
-so-- Z o(.� piire V i_ e LA) r - o r,i
Addr s
Cremation bi u:L-n I,.
Date VJ Lt_n) Place Removed
Removal and/or Held
4. ❑ and/or Address
Hold
Date Point of
Transportation Shipment
I ❑ By Common Destination
4: Carrier
. Date Cemetery Address
❑
Disinterment
Date Cemetery Address
CI Renterment
1 Permit Issued To Registration Number
Name of Funeral Home r tL -€r � r7Y r t h 1,,m / I i n� 0IDa.. j I
Address ` ` r Z L�.'tl♦� !Z ��p
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
( Permission is hereby granted to dispose of the human remains de ed abov 'n
Date 1 I-Z7 ZQ O Registrar of Vital Statistics i
Issued ( gnature)
District Number 101 Place Albany Police Department City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition IZi I i i 5 Place of Disposition ,l`nt V« CO V I k itOr v.-
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 4-5111L,.. t‘erglf
'� J/ (Please print)
Signature 4t1 Title 1
(over)
OH-1555 (9/98)