Zacharias, Walter 'YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Walter Zacharias male
Date of Death Age If Veteran of U.S. Armed Forces,
July 27, 1996 83 War or Dates no
EMedical
th Hospital, Institution or
r Village City of Glens Falls Street Address Glens Falls Hospital
eath 0 Natural Cause ❑Accident Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
ifier Name Title
Christopher Hoy MD
Address
102 Park Street, Glens Falls, New. York 12801
Death Certificate Filed District Number Register Number
Qjjy,Town or Village City of Glens Falls rz
Date Cemetery or Crematory
❑Burial July 29, 1996 Pine View Crematory
f-1 r-r +:^„ Address Queensbury,, New York
— emDate Place Removed
Z ❑Removal and/or Held
... and/or Address
Hold
Q Date Point of
❑Transportation Shipment
fl by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and Denny Funeral Home 01583
Address
53 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
N.
Address
Permission is h reby granted to dispose of the human remains described above a di ated.
Date Issued Registrar of Vital StatisticsXw / 6�
(signature)
District Number
Place
I certify that the remains of the decedent identified above were disposed of in ac rdance with this permit on:
W. Date of Disposition. Place of Disposition
(address)
iUJI
N
(section) (lot n ,be (grave number)
GName of Sexto or Person-in Charge of Premises7� � 1 � ,
(please print)
W Signature r Title
DOH-1555 (10/89) p. 1 of 2 VS-61