Darrah, Melvin J. Jr. . lii. -k-F 5 .g LI
NEWYORKSTATEDEPARTMENTOFHEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Melvin J Darrah Jr Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2022 50 Years War or Dates
1.., Place of Death Hospital,Institution or
'Z City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death I1 Natural Cause Accident Homicide ESuicide Undetermined ❑Pending
11.1
0 Circumstances Investigation
C3
W Medical Certifier Name Title
0 Michael Doyle DO
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 2884
HBurial Date Cemetery,Crematory or Facility Name
12/14/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
a Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
__ Remains are Shipped,If Other than Above
2 Address
Q
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2022 Registrar of Vital Statistics DaniSjillepie(EkarorticaiiSOne'9
(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:
I—
Date6--,
W of Disposition 12]►H IlL Place of Disposition addr. L
)
CO
CC (section) (lot number) (grave number)
G� c
Name of Sexton or Person in Cha e of Premises " 41,-- " tt
(pi print) /'�,� ,,,�y��r
Ili Title r"'/MIX
Signature
DOH-1555(o7/18)p 1 of 2
I ( .4 '
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#