Smaldone, Bruce NEW YORK STATE DEPARTMENT OF HEALTH `e r
Vital Records Section Burial - Tran it Permit
y , Name First Riddle % Last Sex
4.-, BRUCE I SMALDONE MALE
Date of Death Age If Veteran of U.S.Armed Forces,
06/27/2016 86 War or Dates
f .. Place of Death Hospital, Institution
Z City ,Town or Village City of Albany ' or Street Address ALBANY MEDICAL CENTER
aManner of Death Natural Undetermined Pending
W ® Cause ❑ Accident ❑ Homicide ❑ Suicide I] Circumstances ❑ Investigation
W Medical Certifier Name Title
p AMORY COLUM MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1339
Date Cemetery or Crematory
El Burial 06/29/2016 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
H Hold
CO
0 Date Point of
CL Transportation Shipment
CO ❑ By Common Destination
CI Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued To Registration Number
Name of Funeral Home MB KILMER FH 01078
Address
136 MAIN ST., S. GLENS FALLS NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ix,ix,- Address
W
a. Permission is hereby granted to dispose of the human remains de ' ed above as jpdicated.
Date 06/29/2016 Registrar of Vital Statistics r �= --
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:
H i �ni Date of Disposition 71 i I it, Place of Disposition VLJ (.. 0-�i
W (address)
LU
(section) jelot number) (grave number)
0
W Name of Sexton or Person in Charge of Premises /Ll LSe141
(please print)
Signature et Title 1a
(over)
DOH-1555 (02/2004)