WaLL, Walter Joseph 11724
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Walter Joseph Wall Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/25/2021 50 Years War or Dates
i... Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death ❑Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
WMedical Certifier Name Title
G John Keegan Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2956
▪Burial 1 Date Cemetery,Crematory or Facility Name
11/30/2021 Pine View Crematorium
❑Entombment Address
ElCremation Queensbury Town,New York
❑Donation
Z ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
O
4. Date Point of
to j Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2021 Registrar of Vital Statistics <Danielle S Gillespie(ECectronicaCCy Signed)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition /a.?-Zpz/ Place of Disposition 1),` Q (Ar&J (r.Grla- j t-K
W (address)J
W
N CC (section) (lot miler) (grave number)
SName of Sexton or Person in Charof Prem7' Itt7/i0,/ci jt,kxJ
Z (please print)
W Signature Title f�QtT'�
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) - 015390
Receipt
Human remains of (-;.i 2 1 r - `- delivered on • , 20
/
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#