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Dagley, Michael L.
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Michael L Dagley Male Date of Death Age If Veteran of U.S. Armed Forces, March 02, 2020 88 War or Dates 11/29/1978-11/28/1982 Place of Death Hospital, Institution or W City, Town or Village Albany Street Address DVAMC 113 Holland Avenue Albany, NY 12208 0 Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Uj Circumstances Investigation W Medical Certifier Name Title 0 Dr. Bichtram Huynh MD Address 113 Holland Avenue Albany, NY 12208 Death Certificate Filed Alban District Number Register Number City, Town or Village y 0198 021 ©Burial Date Cemetery or Crematory .3 �o�2,o2a tJ ❑Entombment Address ❑Cremation IV d Noy Arlington,VA Date Place Removed ZL_J Removal and/or Held H and/or Address Hold 0 Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Address Name of Funeral F rm Making Disposition or M Whom Ih- Remains are Shipped, If Other than Above Address tY W Permission is hereby granted to dispose of the humWmans a crib ab a indicated. Date Issued March 02, 2020 Registrar of Vital Statisti r' n (signature) District Number 0198 Place DVAMC, 113 Holland Avenue, Albany, New York 12208 t- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3 /a aoio Place of Disposition I'Al ja'&v44 2 (address) Uj V) 4yi?J<Oorl W (section) (lot number) (grave number) C1Name of Sexton or Person in Charge of Premises Z (pleas print) W Signature '0 Title n-v f (over) DOH-1555 (02/2004) Public Health Law Sec. 4145(2b) 7 Receipt Hunan remains of delivered on i , 207. Pine View Cemetery`, Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# DAGLEY NAME MIchael L. Dagley Age: 88 LotOwner:Karen L. Dagley Lot* 21 A Horicon Grave# 1 Case: Concrete Died: 3/2/2 0 2 0 Interred3/1 0/2 0 2 0 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View