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Lucy, John IEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section + Name First Middle Last Sex JOHN DWYER LUCY MALE /' Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2015 80 War or Dates YES k^= Place of Death Hospital, Institution Z City,Town or Village City of Albany or Street Address ALBANY MED 0 Manner of Death Natural Undetermined Pendin la Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances El Investi tion Medical CLtiertifier Name Title + 0 HARRY DEPAN MD Address 43 NEW SCOTLAND AVE ALBANY NY 12208 . Death Certificate Filed District Number Register Number ` . City,Town or Village City of Albany 101 755 Date Cemetery or Crematory ® Burial 04/08/2015 PINE VIEW CEMETERY ❑ Entombment Address ❑Cremation QUEENSBURY, NY 4 Date I Place Removed Z Removal and/or Held © ❑ and/or Address ea. Hold Co as` Transportation Date Point of co ElBy Common Shipment Carrier— Destination El Disinterment Date Cemetery Address i Date Cemetery Address ❑ Reinterment ,' Permit Issued To Registration Number t, Name of Funeral Home REGAN DENNY FUNERAL HOME 01443 Address ;y 53 QUAKER ROAD, QUEENSBURY Name of Funeral Firm Making Disposition or to Whom ... Remains are Shipped, If Other than Above if Address LU O. Permission is hereby granted to dispose of the human remains described above as indicated. Date 04/06/2015Registrar Vital Statistics , Issued of0 (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: iDate of Disposition 4/8/2015 Place of Disposition 71 Quaker Road, Qteensbury, NY 12804 L` (address) can; Hudson 31A 1 ', (section) (lot number) (grave number) O WName of Sext or Person in Charge of Premises Connie L. Goedert (please print) ' Signature „/ ( t— Title Cemetery Superintendent (over) DOH-1555(02/2004)