Lomax, James NEW YORK STATE DEPARTMENT OF HEALTH Burial - Tran#sit Permit
Vital Records Section
' Name First Middle List Sex
James J. Lomax Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/17/2016 62 War or Dates 1977-1996
H Place of Death Hospital,Institution
Z City,Town or Village City of Albany or Street Address Albany Medical Center Hospital
pManner of Death Natural Undetermined Pending
W ® Cause ❑ Accident El Homicide ❑ Suicide El ❑ Investigation
W Medical Certifier Name Title
p Shannon Murawski MD
Address
43 New Scotland Ave. Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 2165
Date Cemetery or Crematory
❑Burial 10/19/2016 Point View Crematory
❑Entombment Address
®Cremation Queensbury, NY .
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
H Hold
N
Date Point of •
d Transportation Shipment
fA By Common Destination
0 El Carrier
❑ Disinterment Date Cemetery Address
El Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St.Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remains d ' ed above as indica
Date 10/19/2016 Registrar of Vital Statistics `o'`^" 40#!!„--
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:
Date of Disposition 10 1a /I L Place of Disposition 'M V fi� �i' mv.„
ftor
tu ' (address)
w
co
00 (section) (lot number (grave number)
CI
/ ;k)p ...• Name of Sexton or Person in Charge of Premises i hA i'f`i
(please print)
Signature L _ Title (RE mi'tPrZ-
(over)
DOH-1555(02/2004)