Maney, Gerald JUL 1814UUb ub:SZP , 5184559144 page 1
-. ' - ? 33
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Amor
Name First Middle Last Sex
,:,... _krald �. .�.. _ Mit 1 Mane Maip
,."f> ... .__,
Date of Death y Age If Veteran of U.S.Armed Forces,
July, 76,, 2006 i 76 War or Dates WWII —. . ..---..-
` Place of Death Hospital.Institution or
,, city,-414AMOW8tYik Al batty__,_•• Street Address St. Peters Hospital
',,, Manner of Death Q Natural Cause ❑Accident El Homicide 0 Suicide Q Undetermined •0 Pending
M.i
__.— —. _ Circumstances_ Investigation
Medical Certifier Naive Title -
',, „- Seruio (tapisarda M.D.
Address
;,.
7 Southwoods Blvd. Albany, New York
„; Death Certificate Filed —_ District Number Register Number
= CityXKd(JilUta MI • Albany 101 ,
Date XXXIX424/or Crematory
OBurial _-Ju_y,•19, 2006 •_ •_ Fine View Crematory-! _
0�1 Address
Cremation Queensbury, .New York
Date Place Removed
Oa Removal and/or Held
and/or Address — - —
Hold
Date Point of
NTransportation _ Shipment
5 by Common Destination
Carrier
0 Disinterment Date Cemetery Address
0 Reintannent Date Cemetery Address
{s,. Permit Issued to j Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home - 1___ 01194
:r'>• Address
11 Lafayette Street__„Queensbjy, New York •-12894 .
A.: Name of Funeral FirmMaking Disposition or to Whom
'tRemains are Shipped, if Other than Above- ..._. —. —. ._-_�.
Address -� -- —
: Permission is hereby granted to dispose of the human remains described above as indicated.
f,. /Fa
r; Date Issued 07/1 of n Registrar of Vital Statistic, s�!� — ¢ l/JYJ
{signature)
District Number 101 Place _ .
I certify that the remains of the decedent identified abovo were disposed of in accordance with this permit on:
ri
W Date of Disposition .7-t`j- ti Place of Disposition f-'- i' 4: (t a lv,'Ito:- i tr.
2 -(address)
w
. ft) _
(section) 1 • (lo umber) (grave number)
Name of Sexton or Person in Charge of Premises C T,a '�t..t tt`
1� j i (phrase print)
Signature (� Title,— C~�' -, i
(over)
DOH-1555(9/98)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
gii Name First Middle Last Sex
Gerald Mitchell Maney I Ma1P
Date of Death Age If Veteran of U.S. Armed Forces,
July 18, 2006 76 War or Dates WWII
Place of Death Hospital, Institution or
2 City, Aztoolamoto Albany Street Address St. Peters Hospital
VA
Manner of Death fj Natural Cause Ili Accident El Homicide El Suicide El Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
i0 Sergio Rapisarda M.D.
Address
7 Southwoods Blvd. Albany, New York
Death Certificate Filed District Number Register Number
CitynalWaXAMt Albany 101
Date Ji XrXXy or Crematory
—Burial July 19, 2006 Pine View Crematory
Address
X I Cremation Queensbury, New York _
Date Place Removed
0 n Removal and/or Held
r- and/or Address
Hold
O Date Point of
NE Transportation Shipment •
0 by Common Destination
Carrier .
U Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
» Name of Funeral Home Maynard D. Baker Funeral Home i 01194 1
':. Address
iiM 11 Lafayette Street Queensbury, New York 12804
cLilili Name of Funeral Firm Making Disposition or to Whom
!w" Remains are Shipped, If Other than Above
14.1 Address
ig
fX
Permission is hereby granted to dispose of the human remains described above as indicated.
ai
Date Issued 07/18/2006 Registrar of Vital Statistics � �G►� - '-/' /t v
(signature)
District Number 101 Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
EDate of Disposition Place of Disposition
w (address)
U)
CC (section) (lot number) (grave number)
AName of Sexton or Person in Charge of Premises
z (please print)
W Signature Title
(over)
DOH-1555 (9/98)