Sears, David NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
DAVID HAROLD SEARS MALE
Date of Death Age If Veteran of U.S.Armed Forces,
-' 09/07/2018 52 War or Dates
Place of Death Hospital, Institution
City , Albany or Street Address ALBANY MEDICAL CENTER
,.: _
Manner of Death 0 Natural ❑ Undetermined ❑ Pending
Cause ® Accident ❑ Homicide ❑ Suicide Circumstances Investigation
4 Medical Certifier Name Title
N. BALASUBRAMANIAM MD
Address
112 STATE STREET, ALBANY NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1994
Date Cemetery or Crematory
• ® Burial 09/12/2018 PINEVIEW CEMETERY
❑ Entombment Address
❑Cremation QUEENSBURY) NY
Date Place Removed
Z Removal and/or Held
0' ❑ and/or Address
I— Hold .
U)
O. Transportation Date Point of
U) ❑ By Common Shipment
0 Carrier—
Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To . Registration Number
Name of Funeral Home RADLOFF FUNERAL HOME, INC., 01425
Address
136 WARREN ST., GLENS FALLS, NY 12801
1, Name of Funeral Firm Making Disposition or to Whom
.fix Remains are Shipped, If Other than Above
Address
iliv Permission is hereby granted to dispose of the human remains described above as indicated.
Date 09/10/2018 ,ct��'r -,-c '6
Issued
Registrar of Vital Statistics
(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: • •
Pi w Date of Disposition 9/1 2/201 8 Place of Disposition Pine View Cemetery Queensbury
(address)
co
W" Oneida 170 & 187 2
I' (section) (lot number) (grave number)
O
wName of Se on or Person in Charge of Premises Connie Goedert
(please print)
Signatur - -e- Vr Title Cemetery Superintendent
(over)
DOH-1-555 (02/2004) •