Chandler, Lloyd NEW YORK STATE DEPARTMENT OF HEALTH / D/b
Vital Records Section i Burial - Transit Permit
Name First MiddT Last Sex
L 1., % 61 4 Lc,,c_ iz-c _
Date of Death � Age If Veteran of U.S.Armed Forces,
15/'a o 15 G <� War or Dates
Place of Death Hospital, Institution
'e City , Town or Village City of Albany - or Street Address
Manner of Death Natural Undetermined ❑ Pending
Cause ❑ Accident ❑ Hom [I]icide Suicide ❑
Circumstances Investigation
ig
Medical Certifier Name Title
-I s i,
^ r,___Sirk iiiio
f Address
„, 4 IQI 5n Akt.•)$oiLi.,--LAve ALA,.,,. N7 / Goss
?Oft:* Death Certificate Filed ' District NumLr Register Number
City,Town or Village City of Albany 101
❑ Date Cemete r Crematory
Burial
7// 7/,)•1)IS" iev, GcM6, +btd/
[� Cremation Address
(Alt.. cc4 ,5��, /0G.w v//
0 Date 1 Place Removed
Removal and/or Held
❑ Hold and/or
Address
tDate Point of
Transportation Shipment
❑ By Common
a Carrier Destination
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Reinterment
,a Permit Issued To Registration Number
Naame of Funeral Hom�D S/1.J re /}�„�nCr ti L /i` �j
.,_E/ j_ ‘.,V `7' y
Address
.w. ‘----7 s 4„,„___ Av, '---,-,._a7t_ &J‘r ia va)_-
* Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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42
Permission is hereby granted to dispose of the hurrin-r�err�ains de ribed '
Date �j Registrar of a Statistics
at Issued ' nature)
1;;, 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:
Z Date of Disposition 1I 0 it r Place of Disposition ` t Uw r . c3 ,i",
tom (address)
IX (section) (lot number) (grave number)
0 [` t
�Z.i Name of Sexton or Person in Charge of Premises `�•1a1 —.Si a,i#
/,,fJ (please print)
Signature ��t, Title (1110iMg ,—,
(over)
DOH-1555 (9/98)