Pelkey, Willaim L ULF spa
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William L.Pelkey Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/09/2023 68 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
tpManner of Death I Natural Cause IllAccident ❑Homicide Suicide Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
0 Syed Saeed 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 1584
Burial Date Cemetery,Crematory or Facility Name
07/11/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
gRemoval Date Place Removed
and/or and/or Held
Hold Address
N
0
tl Date Point of
Cl) Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Ei Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
-. Remains are Shipped,If Other than Above
a Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/11/2023 Registrar of Vital Statistics Dania& yilTe pre(Ekctronrcad Srgne4
(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 I z ( Zj Place of Disposition
(address)
W
O (section) � '!ot number) (grave number)
G Name of Sexton or Person in Cha Premises
(p/e se print) /
W Signature Title `eviv
)k{(Ok
DOH-1555(07/18)p t 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 p rmit
Official Funeral Directors Reg.or License#