Deuel, Jon '-,--
0 NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Pe It
Name First Middle Last Sex
JON J. DEUEL MALE
Date of Death Age If Veteran of U.S.Armed Forces,
05/23/2018 71 War or Dates 1966-68
1- Place of Death Hospital, Institution
W City , Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
ca Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
W Cause Circumstances Investigation
W Medical Certifier Name Title
p DR. SUKHRAJ SINGH MD
Address
43 NEW SCOTLAND AVE ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1149
Date Cemetery or Crematory
❑ Burial 05/29/2018 PINEVIEW CREMATORY
❑ Entombment Address
®Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
H Hold
V) -
0 Date Point of
G. Transportation Shipment
Cl) 0 By Common
p Carrier Destination
❑ Date Cemetery Address
Disinterment
0 Date I Cemetery Address
Reinterment
J
Permit Issued To Registration Number
Name of Funeral Home BREWER FUNERAL H )ME, INC 00211
Address
24 CHURCH ST., PO BOX 500, LAKE LUZERNE, NY 12846
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a',: Address
r
W Permission is hereby granted to dispose of the human remains described above as indicated.
a 05/24/2018
Date Registrar of Vital Statistics
��
Issued
(signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance
with this permit on:
Z Date of Disposition SrellQ Place of Disposition Pa.- l.ht—
u1 (address)
2
u1
co
(section) (lot yrnber) (grave number)
O Ar
Z Name of Sexton or Person in Charge of Premises &+~�'
(please print)
Signature Title 1' 'C.
(over)
DOH-1555 (02/2004)