Thiel, Michael NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
MICHAEL S THIEL MALE
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2014 39 War or Dates
Place of Death Hospital, Institution
City,Town or Village City of Albany or Street Address ST. PETER'S HOSPITAL _
nil Manner of Death Natural Undetermined ❑ Pending
® Cause ❑ Accident ❑ Homicide ❑ Suicide Circumstances Investigation
Medical Certifier Name(n'''''! Title
ERICA FISH DO
Address
315 S MANNING BLVD., ALBANY NY 12208
Death Certificate Filed District Number Register Number
e. City,Town or Village City of Albany 101 2363
Date Cemetery or Crematory
® Burial 12/16/2014 PINEVIEW CEMETERY
0 Entombment Address
❑ Cremation QUEENSBURY, NY
Date Place Removed
2
2 ❑ Removal and/or Held
and/or Address
}-' Hold
0 Transportation Date Point of
Shipment
CO ❑ By Common Destination
d Carrier
❑ Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
' Permit Issued To Registration Number
Name of Funeral Home TUNISON F.H. 01730
;V,$ Address
le 105 LAKE AVE., SARATOGA SPRINGS, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Q. Permission is hereby granted to dispose Zrt : i !
k
Uc
cs ' �G -
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:
WDate of Disposition) /(a(/[� Place of Disposition 2 j r CCket 1J. !OAsko/`zq ,oy.
u rt [ (address) l
/ � '.13 /
re
(section) (lot number) (grave number)
�/��,J/G L 60W Name of Sext9n-or Person in Charge of Premises ��? _�`
/: �l (please print)
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Signat re O!'I,�4zP � . ��',,_�'6 Titl
(over)
DOH-1555 (02/2004)