Dennison, Joseph NEW YORK STATE DEPARTMENT OF HEALTH • # PT
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph W. Dennison Male
Date of Death Age If Veteran of U.S.Armed Forces,
May 23,2017 77 War or Dates 12/12/1964-07/03/1868
Place of Death Alban Hospital, Institution or
City,Town or Village y Street Address DVAMC 113 Holland Avenue Albany,NY 12208
Mariner of Death lijr7INatural Cause Q Accident El Homicide ID Suicide El Undetermined a Pending
Circumstances Investigation
Medical Certifier Name Title
Nicholas Johnson MD
Address
113 Holland Avenue Albany,NY 12208
Death Certificate Filed AlbanyDistrict Number Register Number
City,Town or Village 198 037
101Entor! Date e/7�/'7 Cemez`►{y or C7rnat ry �j
°Entombment-Address ./ �)/� ��e L 7
❑Cremation cP P.�1.;VJCf-x-c� , /U 1
Date Place Removed
Removal and/or Held
_. and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment I5ate Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home C b �{JC g, �afLe4l7/� , oa-tp 9
Address bV°2a p& Ave,.f vl✓. , ,S�.aa fiD 4 Sp .,N y/.�'"��
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 rem I s descri eta 8b di ated.
Date Issued May 23,2017 Registrar of Vital Statistij
•
(signatt o)
„i1 District Number 198_ Place DVAMC, 113 Holland Avenue, Albany,New York 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition c)30)f Place of Disposition 4 ON , r/,r►,fMhwl -../
(address)
(section) 1�/J(loutumber) (AIM 4 (grave number)
Name of Sexton or Person in Charge of Pram es_ �'�
(P se print)
`', Signature 41 : Title etc_rIli1t—
(over)
DOH-1555(02/2004)