Alden, Albert • r
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
-;•% Name First Middle Last Sex
Albert Francis Alden Male
r . Date of Death Age If Veteran of U.S. Armed Forces,
October 23, 2015 68 War or Dates Vietnam
1▪ Place of Death Hospital, Institution or
City, Town or Village Town Of Queensbury, NY Street Address 10 Irongate Road
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Paul Bachman MD
Address
'"'' Main St. Warrensburg, Ny
r ; Death Certificate Filed D„ trict Number Register Number
City, Town or Village Town of Queensbury, NY C `) n
❑Burial Date Cemetery or Crematory
October 26, 2015 Pine View Crematorium
❑Entombment Address
CI Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
▪ Hold
U)
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
;}r. Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
r ; 53 Quaker Road, Queensbury,NY 12804
::j: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
r
•': Permission is hereby granted to dispose of the human remains described above as indicated.
`' b(s lc�-o ( g
'.� Date Issued � 0 Registrar of Vital Statistics
(signature)
9
• District Numberclocr) Place ) O Lyr..\ U c C.. ,
F- I certify that the remains of the decedent identified above were disposed of in acc•rdan.- with this permit on:
W Date of Disposition /o/tilic Place of Disposition rIL r,1ii4-lpnu,.,
2 (address)
W
W
IX (section) (lot nuber) (grave number)
Q Name of Sexton or Person in Charge of Premises (,o— 3,..t
g // (please print)
alSignature Title C/ltie'}p,
(over)
DOH-1555(02/2004)