Falkenbury, Joel ti
NEW YORK STATE DEPARTMENT OF HEALTH 9
Vital Records Section Burial - Transit Per it
Name First Middle Last Sex
Joel E Falkenbury Male
Date of Death Age If Veteran of U.S. Armed Forces,
. i 12/14/2018 69 Years War or Dates 1968-1970
Place of Death Hospital, Institution or
'` 1 City, Town or Village AlbanyStreet Address Albany Medical Center Hospital
ZI 9
Manner of Death a Natural Cause ❑Accident ❑Homicide ❑Suicide I'—'Undetermined ❑Pending
jai Circumstances Investigation
Medical Certifier Name Title
Donald Tessitore NP
Address
43 New Scotland Ave,Albany,New York 12208
PLTI Death Certificate Filed District Number Register Number
-1 City, Town or Village Albany 0101 2757
���❑Burial
Date Cemetery or Crematory
J 12/17/2018 Pineview Crematory- ❑Entombment Address
41,'„®Cremation Queensbury Town, New York
Date Place Removed
-'❑Removal and/or Held
and/or Address
Hold
.. Date Point of
❑Transportation Shipment
by Common Destination
. { Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
44 Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
-: Address
7 Sherman Ave,Corinth,New York 12822
lName of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Aa
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/14/2018 Registrar of Vital Statistics cDanieffe S cilIespie(E(ectronical y Signed)
t . (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:
Date of Disposition oaf ie W Place of Disposition P;iNc \ALW Lrf',k+or,urti
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises ��Rt ' �r''� I le
(please print)
Signature f- Title CT 6.'-'r
(over)
DOH-1555 (02/2004)