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vnj ttecords S ection ::'w`i�+v l OF HEALTH 30
Name -First - - - Burial - Transit permit
.' TODD Middle _ _ Last _ _ __ _
Dale of Death D. CORREA i sex ._ -
—A-U�G�US_T 25, 2006 A�e� - veteran of U.S.Armed ForcAs, MALE
•�'""j pt' ace of Death ---�-?� �--i_ '�Nar or Dates
-+ Cit Towr r 1 ~ Pospital, tnstitu icon
Yam_ o Village City of Albany
"�
Manner of Death y ---�___ _o ,Street address Al BANY MEDICAL CENTER
❑ Natural —
— ...___]
Cause
L Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
rMedical Cent er Name — Circumstances PendiInvestng
HERMAN THOMAS ~Titre -
Address — -- CORONER
�__ 112 STATE ST., ALBANY, NY 12207 � -
i Death Certificate Filed — - ~- --,
+City,Town or Village r- Districtnumber i Register Number
---�� .,tt of Albany J 101 1
! 0 Burial Dale Cemetery or Crematory 1�11
AUGUST 29, 2006 — [Cemetery
CREMATORY
Cremation Address " ---
QUEENSBURY, NEW YORK
Z Date - "� Place Removed '-
0 ❑ and/oval - ____ 1 and/or Held
M-•I _ Hold I Address -_ _" --~— _—.._,
U)1,-
—
Qi Transportation pate j Point of --
-
01 0 By Common _ i Shipment
Si CarrierDestination
❑ Disinterment "ate �'Cemetery Address
Date I Cemetery Address
❑ Reinterment
w
Permit Issued To — FZegistration Number
Name of Funeral Home REGAN & DENNY FUNERAL HOME, INC. 1 01520
Address .' - -
94 SARATOGA AVE., SOUTH GLENS FALLS, NY 12803
1;', , Name of Funeral Firm Making Disposition or to Whom
' .Remains are Shipped, If Other than Above ^
Address
Permission is hereby granted to dispose of the human remains descr above as indicate / 'y
Date AUGUST 29, 2006 �..vti•�..9..__ �' �4.
— - Registrar of Vital Statistics -
Issued
(signature)
District Number 101 M Place City of Altlaty, NY —.___
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition q /3o/bb Place of Disposition Pirtitdu.r t. cep, ors ,
N (address)
W __ _
8
(section) / (lot number) (grave number)
te
Z Name of Sexton or Person in Charge of Premises [� 1,r S Q n t —__
ILJ
ii 7'L ___ (please print)
Signature Title 1.rc ra s dr
_...._..
(over)
DOH-1555(9/98)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
e
Name First Middle Last Sex
TODD D. CORREA MALE
Date of Death Age If Veteran of U.S.Armed Forces,
AUGUST 25, 2006 27 War or Dates
N Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
W Manner of Death Natural ❑ Undetermined ❑ Pending
W' ❑ Cause IS] Accident ❑ Homicide El Suicide
Circumstances Investigation
Medical Certifier Name Title
G HERMAN THOMAS CORONER
Address
112 STATE ST., ALBANY, NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1511
Date Cemetery or Crematory
❑ Burial AUGUST 29, 2006 PINEVIEW CREMATORY
Address
® Cremation QUEENSBURY, NEW YORK
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
H Hold
Cl)
0 Date Point of
O. Transportation Shipment
CO ❑ By Common
G Carrier Destination
El Disinterment
Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home REGAN & DENNY FUNERAL HOME, INC. 01520
Address
94 SARATOGA AVE., SOUTH GLENS FALLS, NY 12803
N Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains descr e above as indicated", ')
Date AUGUST 29, '"X`"
2006 Registrar of Vital Statistics '�— (�J- {�
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZDate of Disposition t/3 o AL Place of Disposition P i n av,e.4 CC Ore 4.i of
ili (address)
w
U)
ce (section) (lot number) (grave number)
0
0
w Name of Sexton or Person in Charge of Premises hr:J Sc.,nctt
,� /�(please print)
Signature 4,„( Title C,t 4}or
(over)
DOH-1555 (9/98)