Karaczan, Walter NM YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section —
Name First Middle Last Sex
WALL ER WILLIAM KARALZ�aN I"1
.. : _
Date of Death Age If Veteran of U.S. Arme ..........
Forces,
i`_ttiiEifi�34 r'+ War or Dates WWI
Place of Death Hospital, Institution or
City,Town or Village t3REENF- ILL.U Street Address 16 YOUNG ROAD
.. .:,::.. . .:. . .. ............
O Idlanner of Death Natural Cause Accident Homicide Suicide ❑ Undetermined .� Pending
a7.t Circumstances Investigation
... .... ::.-.: ...... .::.::. .. ..: .: ... ... .......:.. ... .... ..... __ ..
Medical Cert'rfier Name Title
'1 F-IOMAS G. LUTZ, M. U.
0' ......
....... ..:.::.... .::::. ..:: .:....: ... .:..... _.,,:. ...._::..:
Address
I I(-')I NO'I I` `S 7". , SLHENL.0 l HIa y,
.:_ _ .
Death Certificate Filed District Number Register Number
City,Town or Village
bREENI� 1ELli 4557 f3
Date 08/22/94 Cemetery or Crematory PINE VIEW CREIr1A`f"OR'Y
❑Burial
..-... .......: .... -....... ..
Address
[]Cremation QUEENSRURY, N. Y.
._
Z Date Place Removed
O; Removal and/or Held
1_— and/or Hold .............. ............................ ... I....... .......................
: Address
N
0:::::.. ::_::::. ..
CL Date Point of
Ln Transportation by Shipment
p Common Carrier .......
Destination
_. _ . _ _ __ __ __ _
Disinterment Date Cemetery Address
........... _ _ _ _
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm W I LL I AM BURKE £C SONS FUNERAL i 0i;�6'7
__
Address /�
626 NO. >LROADWAY, SARATOGA SPGS, N. Y. 3yB66
}-; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
i1.
Permission is hereby granted to dispose of the human re ain described above as)
Date Issued 08 i 23 9 Registrar of Vital Statistics
(signature)
4557 GREENF IELD
'i District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Place of Disposition / i /4E
g (address)
w
cc (section) (lot number) (grave number)
p Name of Sexton Person ' Charge of�Preises
Z; (please print)
W r Signature Title
DOW1555 (10/89) p. 1 of 2 VS-61