Welch Sr, Peter NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
r
Name PT R A. WELCH SR. Middle Last Sef1ALE
Date of Death Age If Veteran of U.S. Armed Forces,
4/23/99 88 War or Dates NO
Place of Death Hospital, institution or
City, Town or Village GLENS FALLS Street Address GLENS FALLS HOSPITAL
Manner of Death®Natural Cause ❑Accident [:]Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
FRED P. SCIALABBA MD
Address
454 GLEN ST. , GLENS FALLS, NY 12801
Death Certificate Filed District Numb r Register Number
City, Town or Village GLENS FALLS 6'J
Date Cemetery or Crematory
❑Burial 4/26/99 PINE VIEW CREMATORY
Address
❑Cremation QUEENSBURY, NY
Date Place Removed
o ❑Removal and/or Held
••• and/or Address
Hold
En
Q Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
XX
Permit Issued to Registration Number
Name of Funeral Home EDWARD L. KELLY FUNERAL HOME 01045
Address
SCHROON LAKE, NY 12870
i Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains ftscribed ab a as ' is ted.
Date Issued�_ Registrar of Vital Statistics
(signature)
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ! Place of Disposition r/v,4F %. I�' Li�i / /1 �>l1✓��
(address)
J1J
W
9One� (lot number)—
J�grave number)
a Name of Sexto or Person in Charge of Premises,
g - (please print) �- f
Signature Title %G JCS r
DOH-1555 (10/89) p. 1 of 2 VS-61