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Farenell, Larry t • 3 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Larry Menlo Farenell Male Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2017 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©Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Ingrid Bedinotti PA Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City, Town or Village Albany 0101 2916 ❑Burial Date Cemetery or Crematory 01/02/2018 Pine View Crematory El Entombment Address ®Cremation Queensbury, New York Date Place Removed ttw'IRemoval and/or Held and/or Address Hold 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 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 `' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/02/2018 Registrar of Vital Statistics oantea sgilrespie EfictronicalTySigned (signature) District Number 0101 Place Albany, New York certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ill l j I g Place of Disposition .�,�a,td (cte res k'. (address) (section) h (lot number) /' (grave number) Name of Sexton or Person in Charge of Premises ^„ 1, I.',&t cmp (p se print) Signature U -2'9%' Title ( iuti id (over) DOH-1555(02/2004)