Schulz, Bernard M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Bernard M.Schulz Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/13/2020 65Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Alban Street Address Albany Medical Center Hospital
p Manner of Death ®Natural Cause Accident ❑Homicide ❑Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Michael O'Brien
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0087
Burial Date Cemetery,Crematory or Facility Name
01/15/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
A ❑Removal Date Place Removed
and/or and/or Held
N
Hold Address
a.. Date Point of
N Transportation Shipment
Q by Common —
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
II.- Remains are Shipped,If Other than Above
2 Address
cc
W
CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/14/2020 Registrar of Vital Statistics dDanielle S Cjillespie(Efectronicat y Signed)
/signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 1 116 u, Place of Disposition
� /address)
W
N /section) )lot number) (grave number)
��
C (p Name of Sexton or Person in Charge f Premises I^�1d
Z D /pl a print)
W Signature �+ aC' Title
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013246
Receipt
Human remains of delivered on , 20
s
Pine View Cemetery Representing the funeral home named on"burial permit
Official Funeral Directors Reg.or License# .,