Loveday, William NEW YORK STATE DEPARTMENT OF HEALTH t 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William D. Loveday Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/08/2013 75 War or Dates
Z Place o eath Hospital, Institution or q-/ . j1' / 147/,i, ✓4-%-v--
w` City,(Ir Village B 7 ('�
d/ 7 Street Address Deceased's Residence .i
19 Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide ri Undetermined ri Pending
L� Circumstances Investigation
Ill Medical Certifier Name �� Title
CI WILLIAM C. ORLUK,
Address
6223 State Rte 9 Chestertown, NY 12817
Death Certificate Filed ' • District Number Register Number
/ City,jobr Village / 1/L1 5&54
❑Burial Date Cemetery or Crematory
02/11/2013 1
❑Entombment
Address
®Cremation
Date Place Removed
z El Removal and/or Held
and/or Address
}; Hold
lA Date Point of
0 Transportation Shipment
CO by Common Destination
CI Carrier
0 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
W
tL Permission is hereby granted to dispose of the human rem ins described above as ind- ated.
Date Issued,--//- /3 Registrar of Vital Statisti ‹ ,f,�
(signature)
District Number goo 91 Place 4-1AC..0-,/-%-
1.- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition tit-t3 Place of Disposition +.atncNi C of a .
2 (address)
W
CO
X (section) (lot number) (grave number)
0 ii
Name of Sexton or Person in Charge of remises �ri5 �r �N
(Pease print)
W Signature Title Ceimlfi%
(over)
DOH-1555(02/2004)