Bailey, Richard NEW YORK STATE DEPARTMENT OF HEAL/H. \,
Vital Records Section Burial - Transit Permit
Name First Middle Last Ite
Richard A . BAILEY •
Date of Death Age If Veteran of U.S. Arme F _rr o
10/1 0/13 6 5 War or Dates
14, Place of Death Hospital, Institution or
City, Town or Village Albany Street Address VAMC , Albany , NY 12208
lii0 Manner of Death®Natural Cause p Accident El Homicide Suicide ❑Undetermined ❑Pending
I Circumstances Investigation
La Medical Certifier Name Title
Anthony Giuffrida MD
Address DVAIT 113 Holland Avenue, Albany, New York 12208
iiN Death Certificate Filed District Numbei1 Register Number
Alban
City, Town or Village y 12 5
❑Burial Date 10/10/13 Cemetery or Crematory
pt`n. J,y,,J C t•-C.rv.....iiit l'.,
0 Entombment Address `,K 0 �
ECre,mation V' k '/W1 t�CJ LA.ti,& 1Gt WI , �L/ J// 2- bi7 y t
Date Place Removed
❑Removal and/or Held
., and/or Address
R
Hold
0 Date Point of
Transportation Shipment •
Et by Common Destination
Carrier
Disinterment Date Cemetery Address '
Q Reinterment Date Cemetery Address
;ss Permit Issued to tirjaration Number
Name of Funeral Home Compassionate Care Ill
Address
402 Maple Avenue, Saratoga Spgs., New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
,'; Address
tr
to
Permission is hereby granted to dispose of the humaanv1r sins de cr b s- dicated.
Date Issued 10/10/13 Registrar of Vital Statistic3" " � t er, eteran Service Center
(signature)
District Number 198 PlaceVAMC 113 Holland Ave . ,Albany , NY 12208
;::; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
111 Date of Disposition/O//13 Place of Disposition gw,e_ ,fr...--- (� why
2 (address)
iii
ta
• (section) lt nIer)� (grave number)
Ct Name of Sexto fr Per n Charge of Premises /'`�d
(please print))
ni Signature Avzi Title ( i 2 /7S 1
(over)
DOH-1555 (02/2004)