Granger, John 4.-
NEW YORK STATE DEPARTMENT OF HEALTH '.
Vital Records Section Burial - Transit Permit
,,,...
Name First Middle Last Sex
a JOHN RICHARD GRANGER MALE
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Date of Death . Age If Veteran of U.S. Armed Forces,
ost
. ;IR 2/26/2016 77 • War or Dates 1956-1959 -
Place of Death Hospital, Institution or COMMUNITY HOSPICE OF ALBANY
M City' Town or Village ALBANY Street Address . 315 S. MANNING BLVD.
ill
Manner of Death J Natural Cause El Accident 0 Homicide El Suicide El Undetermined r----i Pending
ligt 'Circumstances ""I Investigation
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Medical Certifier Name Title
PATRICIA DORNEY M.D. .,
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Address
NO 315. SOUTH MANNING BLVD. ALBANY, NY 12208 .
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Elo Death Certificate Filed District Number Register Number
itig!
gli City, Town or Village ALBANY 101 445
Alt DBurial Date Cemetery or Crematory •
3/4/2016 PINE VIEW CEMETERY .
ge 0 Entombment •
* . Address
, A OCremation QUEEN S BURY, .NY •
ikft .
Date Place Removed
A.E1 Removal •
and/or Held •
and/or Address
Hold
VI •
. .
0 • Date Point of
1 I 0 Transportation Shipment
6 by Common Destination
E4 Carrier
- M 0 Date Cemetery Address El Disinterment
0 Reinterment -
Date - Cemetery Address
0 Permit Issued to - • Registration Number
Pi Name of Funeral HomeREGAN DENNY STAFFORD FUNERAL HOME .
01443
g.ii. Address
A ..
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NT 53 QUAKER RD. QUEENSBURY, NY 12804
•A Name of Funeral Firm Making Disposition or to Whom -• •. .
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1#i•, mans areShipped, IfOther than Above •
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Address .. . -
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111 • . .
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im Permission is hereby granted to dispose of the human remainsdescrib d above as ind-cated. •
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- .' .. . . .. 44,4ie___
Date Issued 2/27/2016 - Registrar of Vital Statistics It zitr- (signature)
ia
Ps District Number 101 • Place ALBANY POLICE DEPT. . •
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11 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: -
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In Date of Disposition . 3/4/201 6 Place of Disposition Pine View Cemetery, Queen s bury,NY
(address)
1 •. Erie 36B 1
ra .
(section) (lot number) (grave number)
0
d Name of Se 4 I or Person i harge of Premises Connie L. Goedert
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I /ta-c.e
it Signature, •42 el_.e....4---( Title Cemetery Superintendent
• (over)