Willigan, Jr. Edward NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward Bernard Willigan, Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/16/2012 71 War or Dates No
}- Place of Death Hospital, Institution or Community Hospice of Albany
City, Town or Village City of Albany Street Address at St. Peter's Hospital
tiLiQ Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending
t Circumstances Investigation
tit Medical Certifier Name Title
iQ John E. Caracandas M.D.
Address
400 Patroon Creek Blvd., Albany, NY 12206
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 0101 . J es I
<[ ®Burial Date 1 Cemetery or Crematory
11/20/2012 Pine View Cemetery
❑Entombment Address
': ❑Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
An
0 Date Point of
❑Transportation Shipment
d by Common Destination
Carrier
E]Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
<` Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
iiii 11 Lafayette Street, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
to
Ill
Permission is hereby granted to dispose of the human remains described abo e as indicated.
iii
Date Issued 11/19/2012 Registrar of Vital Statistics .
(signature) M..
`' District Number Place Cityof Albany, New York
0101
1-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
UI Date of Disposition Place of Disposition
12 (address)
0
C (section) (lot number) (grave number)
QName of Sexton or Person ip Charge of Premises
z (please print) •
til
Signature Title
(over)
DOH-1555 (02/2004)