Hollenbeck, Paul G. NEW YORKSTATE DEPARTMENT OF HEALTH BUriai - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul G Hollenbeck Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/16/2020 53 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
`p Manner of Death Natural Cause Accident 0 Homicide Suicide Undetermined Pending
LI
C.) Circumstances Investigation
W Medical Certifier Name Title
13 Paul Marra Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0842
Burial Date Cemetery,Crematory or Facility Name
04/20/2020 Pineview Crematory
Entombment Address
RclCremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
d Date Point of
toElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/20/2020 Registrar of Vital Statistics Danielle S Gillespie(Electronically 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:
H ,
Z Date of Disposition 41101ZO Place of Disposition OCIw
/address)
W
N
IM /section) (!ot number/ /grave number)
0 Name of Sexton or Person in Chang remises rt
C...� lease print)
Z
W Signature 67 Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 71
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#