Telford, Wesley Lloyd te,CAD
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Wesley Lloyd Telford Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/13/2022 1 Mos.18 Days War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
0▪ Manner of Death Natural Cause Accident El Homicide Suicide Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Gina Geis MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1865
Burial Date Cemetery,Crematory or Facility Name
08/15/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
H
N Hold Address
0
a. Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
CC
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/15/2022 Registrar of Vital Statistics [nanie1Te S C i((espie(E(ectronica1TySigned)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 131/10 I?Z Place of Disposition
W
2 (address)
W
CC
(section) (lot number) (grave number)
• Name of Sexton or Person in Charge of 7nises / Gi L to Jar
Z (plose print)
Signature C/ Title rizo1fi k
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ,�.. delivered on • , 20
Pine View Cemetery - Representing the funeral home named,on,burial penit
Official Funeral Directors Reg.or License#