Welch, Daniel .
NEW YORK STATE DEPARTMENT OF HEALTH # ;?37
Vital Records Section Burial - Transit'Permit
Name First Middle Last Sex
Daniel Welch Male
Date of Death Age If Veteran of U.S. Armed Forces,
4-08-14 66 WarorDates09/19/67 .-- 9/6/70
f4, Place of Death Hospital, Institution or
City, Town or Village Albany Street Address V A MC , 113 Holland Ave ,Alban y
p Manner of Death 0 Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
p Matthew Lawrence MD MD
Address
113 Holland Ave . ,Albany , NY 12208
Death Certificate Filed District Numbe q Register Numb
City, Town or Village 1 d
❑Burial Date Cemetery /
DEntombment WI c AC t V R/ Y1`'�Address
[Cremation CA V e L N% u0 t(- yera/;
Date Place Rernofved
Z Removal and/or Held
9❑and/or Address
�
3 Hold
0 Date Point of
n" Transportation Shipment
ci by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Riii❑Reinterment Date Cemetery Address
iliEiiigi Permit Issued to _ Registration Number
Name of Funeral Home ) b\t`I4/2 ,L- K 4-Y 06 t 1
Address
Seitike1614 J kk i L t tS.V74
Name of Funeral Firm Making Disposition or to Whdm
Remains are Shipped, If Other than Above
2 Address
1
t
cu
HH Permission is hereby granted to dispose of the human remains des ib e,ndicated.
Date Issued �V `�t- Registrar of Vital Statistits M'e s AT r i n g t on
(signature)
Giii District Number Place
I cI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ILI Date of Disposition t/il I:1 Place of Disposition .(',np,VA,,I CA.. {0r:•S.`
2 (address)
1iUt
La
CC (section) 4(lot number)r (grave number)
a Name of Sexton or Person in Ch rge of Pre ises ii t" `
2 (ple a print)
Signature '`r L Title COCiodlitict
(over)
DOH-1555 (02/2004)