Anderson, Troy NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Troy D. Anderson Male
................... ......... .................................I.I........................,.,...,...�.I.....,.......................,...........,.......,.,...,.I............................................................ ..............................
Date of Death Age If Veteran of U.S.Armed Forces,
Aug. 24, 1991 23
War or Dates No
.. .......................... ....................... ............. ............... ..................
Place of Death Hospital, Institution or
id City,Town or Village Town of Easton : Street Address Burton Rd.
... ... .....
......Manner........ ..... ..... ......................................... ............ ........................I... ..............................I...................... .......... .........................
Manner of Death Natural Cause F&] Accident El Homicide D Suicide o Undetermined Ei Pending
ILI:
...... Circumstances Investigation
V- ..................... ................. .......................
:Q Medical Certifier Name Title
:Q
.......... .................................................................................................... .........................................................................................................................................................
Address
....................................................................................................................................... ...............................................................................................................................
Death Certificate Filed District Number Register Number
City,Town or Village Aug. 25, 1991
Date Cemetery or Crematory
❑Burial
..........Aug 2 6.r....1991 Pine View Cremator
.-.-... ................. .............................. ..........I....... ..................
RiCremation Address
Queensbury, NY 12804
.............. ....................................................................................I..........I................................................. ...........-........................................-.............................-
z Date Place Removed
2 El Removal and/or Held
I- and/or Hold ...... ..... .........
Address
.---.......-..................................-.1............................ ...............-
Fn
0............W-W.,-,............. ... .........
ILDate .......................................................Po.........int.....of............. ............ ...................................................................................
Ln E]Transportation by::
Shipment
aCommon Carrier ...................... ............. ................-........... .................... .........-..... ............
Destination
..............................-............... ..................................... .......................................... ................................................. .................
Cemetery Address
Date.......
El Disinterment
........ .............
....................................................................................... ...................................................................................... ............................................
Cemetery Address Date
E Reinterment
Permit Issued to Registration Number
Name of Funeral Firm Flynn Bros. Inc. 00667
............................................................................................... ......... ....................................................... ........ ...... .......................
...... Address
80 Main Street Greenwich, NY 12834
...................... .......................................................................................................................... ............ ............... ........... ........................... .........
Name of Funeral Firm Making Disposition or to Whom
Re
mains are Shipped, R Other than Above
............ .............................. .......................... ............... ............................................ ......
1r ..................... .........
Address
....... ..........-....... ....... .............--
................................................................................... ................................ ....... ................ ........ ....... ....................... ......
�...... Permission is hereby granted to dispose of the human rerpains described bove as indicated.
Date Issued 8-25-91 Registrar of Vital Statistics
......
(signature)
District Number Place Town of Easton, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F-m Disposition 0( 1
z Date of Disp � -Oz Place of Disposition I/10/1
W
2 (address)
LLJ
U):
cc (section) (lot number) (grave number)
0
Name of Sexton or erson in Cj�rge of Premisqs.�� / g
z (please print)
W 'Signature Title CAr E/jv/ 2� 7
............................... ..................................................................... ............................... .................. ...... .............. ......................................
DOH-1555 (10/89) p. 1 of 2 VS-61