Callahan, Raymond -717
NEW YORK STATE DEPARTMENT OF HEALTH a_
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Raymond E Callahan Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/27/2018 66 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death a Natural Cause El Accident Homicide Ei Suicide Undetermined �Pending
Circumstances Investigation
Medical Certifier Name Title
Mary Maskell-Amirault NP
•
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 2132
❑Burial Date Cemetery or Crematory
10/01/2018 Pineview Crematory
['Entombment Address
®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
Date Cemetery Address
❑Disinterment
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
Y,. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/28/2018 Registrar of Vital Statistics DameLTeSGillespie(E1 ctronicalTySigned)
(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 1012 I(b' Place of Disposition
(address)
(section) Ai(lot number) (grave number)
Name of Sexton or Person in Charge of Pre ises l 4t etror )t "
(plekse print)
Signature Title Axis irAA.
(over)
DOH-1555(02/2004)