Feldesien, Francis Edward NEW YC RK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau,if Vital Records
Nam First Middle Last Sex
Frat cis Edward Feldeisen Mate
Date 1 Death Age If Veteran of U.S.Armed Forces,
030 12022 78 Years War or Dates
p., Ptak of Death Hospital,Institution or
Z City, ;own or Village Albany Street Address St Peters Hospital
Man;ierof Death Undetermined Pending
Natural Cause Accident Homicide Suicide
tit Circumstances Investigation
C)
tit Medi_al Certifier Name Title
Zothanmawii Khiangte MD
Address
315 3 Manning Blvd,Albany,New York 12208
Deal r Certificate Filed City Of Albany District Number Register Number
City, [own or Village 0101 0545
E Trial Date Cemetery,Crematory or facility Name
03iO4/2022 Pine View Crematorium
E Atombrnent Address
OC emation Queensbury Town,New York
nD Dnation
�R moval Date Place Removed
a rd)or and/or Held
)ld Address
0
CL Date Point of
Cl)❑T ansportation Shipment
Q b/Common
C irrier Destination
Date Cemetery Address
❑E: simefluent
Date Cemetery Address
R.?i me r me nt
Pert it i ssued to Registration Number
Nam of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Addr ss
9 Pi,;e St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
�._ Rem fins are Shipped,If Other than Above
Addr.ss
CC
Lu
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/04/2022 Registrar of Vital Statistics Dania&S gisTespt (Ekafani aj'Jigtu4
(signature)
Distr a Number 0101 Place City Of Albany
I cen;ty that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
2 Date of Disposition Place of Disposition ,fie etj_'
tit (address)
tit
N (section) (tqt number) (grave number)
Nam of Sexton or Person in Charge remise - ?fq y1o�c) hJo d
Z / (please print)
4/ Title 7 er der-
5rgn._ture /f l
DOH 1555 (o1)t8)p t of 2
:L5 47
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#