Grant, Fred NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First n Middle Last Sex
d/ 1-7
Date of Death Age If Veteran of U.S. Armed Forces
War or DatE-,
Place of Death Hospital, Institution or
City, Town or Village City of Albany Street Address
Manner of Death ES]Natural Cause Accident Homicide Suicide Undetermined El Pending
Circumstances Investigation
Medical Certifier ae Title
A�m P .
Addr ss
Xo
6�h G o
Deaffi Certificate Piled District Number Register Number
City, Town or Village C ity of Albany
]O l
Dater I emetery or Crematory _/
❑Burial G/1 �i C -P 6") GtQryr�X)
Address
'Cremation
Date lace Removed
❑Removal and/or Held
••. and/or Address
Hold
Date Point of
M Q Transportation Shipment
d by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Hom
Addres /
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 d abo indicated.
Date Issued /-:2- Registrar of Vital Statistics
signature)
District Number 101 Place Albany Police Department Albany, N . Y .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
g Date of Disposition/7: ----'26—Place of Disposition l�/ /1C�"" /,cam _��iCC/� Z/— 'Vw,
(address)
JWU
(section) (Iber grave number)
Name of Sexton r Perso in Charge of FPemises ^;-
g (please print)
Signature Title or
DOH-1555 (10/89) p. 1 of 2 VS-61