Dunn, Hunter NEW YORK STATE DEPARTMENT OF HEALTH r
Vital Records Section Burial - Transit Permit
Name First _I. fiddle Last Sex
wn+er D.,•�es �LAhh #411L�
Date of Death Age If Veteran of U.S.Armed Forces,
II / 17 /a D7I y_. __,., „ti-/--- War or Dates
I-- Placeof Death ! ` Hospital, Institution A
W City,Town or Village City of Albany or Street Address L, ,i4 j u.L
G Manner of Death Q Natural ❑ ndetermined "—I Pending
❑ Accident ❑ Homicide ❑ Suicide
illCause ircumstancesInvestigation
P Medical Certifier Name Title \
Address
(/�j
Death Certificate Filed 'District Numle Register Number
City,Town or Village City of Albany 101
Date Cemetery or Crematory
[I Burial ( ( ll
❑ Entombment 9 l 2-el-2 �.'n�V:c w ciec..4.-{-t�r�
13 Cremation Address
�^^2� ^ A I
CXGes ,kr Iv - r
Date 0 1 Place Removed
Z' Removal and/or Held
Q' ❑ and/or Address
H Hold
Cl)
Date Point of
C, Transportation Shipment
Cl) ❑ By Common
p Carrier Destination
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home ,--gs".orc -tc,,L 1-}„K �,,,� 0 �' `8
Address
L7 Sla Ave. }
m•+ f�V t..Wc_ N.. Y 1 °,qa,�--
Name of Funeral Firm Making Disposition or to Whom
F_' Remains are Shipped, If Other than Above
eta Address
W
D• Permission is he eby granted to dispose of the human remains ' d above a i is
Date ` ( / l 7 / a 0 I L Registrar of Vital Statistics-'�_
Issued .,"' ignaturee
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 iI/i(I IL Place of Disposition �f► ,Uti i (meek rton—
W (address)
w
Cl)
0'
0 (section) (lot number) (grave number)
G ,y
z Name of Sexton or Person in Charge of Premises ar:J'it^ �hr[il
W (please print)
Signature ,(PL J r- Title eat rid} ' .
(over)
DOH-1555 (02/2004)