Mayer Sr., Louis NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
- Name First Middle Last Sex
Louis Norton Mayer Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
01/05/2018 85 Years War or Dates Army
1- Place of Death Hospital, Institution or
ZCity, Town or Village Albany Street Address Albany Memorial Hospital
0 Manner of Death X❑Natural Cause ❑Accident ❑Homicide ElSuicide ❑Undetermined ri❑Pending
III Circumstances Investigation
W Medical Certifier Name Title
CI Frederick Griffiths MD
Address
600 Northern Boulevard,Albany,New York 12204
Death Certificate Filed District Number Register Number
''; City, Town or Village Albany 0101 0029
❑Burial Date Cemetery or Crematory
01/09/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
mri Removal and/or Held
and/or Address
CO Hold
O Date Point of
Q Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tY
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/08/2018 Registrar of Vital Statistics DanielleS Gillespie(ECectronicallySigned)
(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:
2
W Date of Disposition 1/ °I I I8 Place of Disposition ?alb-1 erred 0 c
W (address)
M
Ce (section) / (lot number) (grave number)
pName of Sexton or Person in Charge of Premises CAA. J e...*t-
z (pl se print)
W Signature /�"r Title Tot VAR
9
(over)
DOH-1555 (02/2004)