Lamagna, Robert A. I�
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NEW YORKSTATE DEPARTMENT OF HEALTH - r Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert A.Lama na Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/22/2020 80 Years War or Dates 1956-1959
Place of Death Hospital,Institution or
WCity,Town or Village Alban Street Address Albany Medical Center Hospital
p Manner of Death ®Natural Cause FlAccident Homicide Suicide Undetermined Pending
(Wj Circumstances Investigation
GMedical Certifier Name Title
John Shultz MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0895
Burial Date Cemetery,Crematory or Facility Name
Fj04/24/2020 Pine View Crematory
Entombment Address
XCremation Queensbury Town,New York
Donation
0 ❑Removal Date Place Removed
and/or and/or Held
C-N Hold Address
O
d Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home ---700037
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
IM
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/24/2020 Registrar of Vital Statistics DanieCle S GiClespie(ECectronicaffy 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:
F— t
Z Date of Disposition Jy-7-7-Z,Ctj?A Place of Disposition
W
W
CO)
cc (section) (lot number) (grave number)
GName of Sexton or Person i ha of Premises
Z (please print)
W
Signature Title G�f� kY2 'oza
DOH-t555(07/18)p t of
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Public Health Law Sec. 4145(2b) 0 1 '3 G-4
Receipt
Human remains of delivered on , 20
Fine View Cemetery Representing the funeral home named o)a burial permit
Official Funeral Directors Reg.or License# 1`