Whitesel, John NEW YORK STATE DEPARTMENT OF HEALTH Vitae Records Section Burial - Transit Permit
Name First Middle Last Sex
John R. Whitesel Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/24/2012 43 War or Dates No
II- Place of Death Hospital, Institution
W
City,Town or Village City of Albany or Street Address Albany Medical Center Hospital
O Manner of Death ® Natural ElAccident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
LU Cause Circumstances Investigation
✓ Medical Certifier Name Title
p' Farhana Chaudhary MD
Address
AMCH 43 New Scotland Avenue Albany, NY 12208
Death Certificate Filed District Number I Register Number
City,Town or Village City of Albany 101 01596
Date Cemetery or Crematory
O Burial 03/30/2012 Pine View Cemetery
❑ Entombment Address
❑ Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
Hold
N
O Date Point of
a Transportation Shipment
Cl) ❑ By Common Q Carrier Destination
Date Cemetery Address
❑
Disinterment
Date Cemetery Address
❑
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road Queensbury, NY 12804
F- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ix• Address
UJ
D- Permission is hereby granted to dispose of the human remains described above as iinndica�tend. /
Date 03/26/2012 Registrar of Vital Statistics �-Pn.��e, `-� ' `-� /
Issued (signature) (SL
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:
E—> Date of Disposition 3/3 0/1 2 Place of Disposition Pine View Cemetery
W' (address)
N Erie 39 A 4
O (section) (lot number) (grave number)
0
Z Name of Sexton or Person in Charge of Premises Michael Genier
uJ' y n , (please print)
Signature 1t^^"�`.. Title Superintendent
(over)
DOH-1555 (02/2004)