Randall, Daniel NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Daniel F. Randall
Male
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Date of Death Age If Veteran of U.S.Armed Forces,
Unknown 69 War or Dates no
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Hospital, Institution or
.6,! Place of Death
City,Town or Village Saratoga Springs Street Address 10 b 3 Vanderbilt Terrace
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1U: Manner of Death [] Natural Cause E] Accident El Homicide El Suicide Ei Undetermined E] Pending
Circumstances Investigation
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Medical Certifier Name Title
o Russell B. Peacock
MD.
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Address
Box 68 Greenfield Cemter,NY-12833
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Death Certificate Filed District umber Register mber
City,Town or Village Saratoga Springs 4501 log
Date Cemetery or Crematory
E]Burial
March.... in ....View.. ....... ........
................... . ....F e. ..Cremator
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QCremation Address
Town of Queensbury,New York
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,z Date Place Removed
2 E] Removal
and/or Held
and/or Hold .......... ..... ............ ............... ....... ................................. ................... ...................
Address
0........................ ...........................................-.......................................................................................... ................ .... ............ ....................... .. ..
(L Date Point of
u) E]Transportation by:: Shipment
EiCommon Carrier ......... ....... .......-..................................................................................................................
...Destination...***''...'''....................
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Date Cemetery Address
El Disinterment
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Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Firm William J. Burke & Sons Funeral Home 00264
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...... Address
628 North Broadway, Saratoga Springs,New York,12866
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.................... Disposition
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Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
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Address
ALL
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Permission is hereby granted to dispose of the h man re ins de cribed above as i icated.
Date Issued 3/27/92 Registrar of Vital Statistic
-signature)
District Number 4501 Place Saratoga Springs - NY-12866
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IA9
Z Date of Disposition. —c2 Place of Disposition W06
LU
2 (address)
LLJ
(section) (lot number) (grave number)
0
0 Name of Sexton Person 1 harge of Premises
z (please print)
LU
Signature Title
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DOH-1555 (10/89) p. 1 of 2 VS-61