Schultz, Paul 4 5Z.6
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Paul Robert Schultz Male
Date of Death Age If Veteran of U.S.Armed Forces,
October 17, 2011 54 War or Dates No
I- Place of Death Hospital, Institution
WCity,Town or Village City of Albany or Street Address Albany Medical Center Hospital
G Manner of Death Natural Undetermined Pending
W El Natural
❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
O Medical Certifier Name Title
c Paul-Michel Dossous MD
Address
43 New Scotland Avenue Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1918
Date Cemetery or Crematory
❑ Burial October 21, 2011 Pine View Crematorium
❑ Entombment Address
® Cremation 21 Quaker Rd. Queensbury, NY 12804
Date Place Removed
Z ❑ Removal and/or Held
and/or Address
H Hold
Cl)
Q Date Point of
i L Transportation Shipment
Li) ❑ By Common Destination
CI Carrier
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
Address
53 Quaker Road Queensbury, NY 12804
E- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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a- Permission is hereby granted to dispose of the human remains descr' ed above as i dicact d..��
Date October 19, 2011 Registrar of Vital Statistics ✓'� � / �"�� 0
Issued signature)
District Number 101 Place City of Albany, NY CCCJJJ
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z' Date of Disposition IO I?i I II Place of Disposition Pi K Lt./ Corenctof tor►
w' (address)
E
w
co
ce (section) (lot number)...., (grave number)
0
0
Z' Name of Sexton or Person in Charge of Premises t 10- s C41.4N
w (please print)
Signature + J Title (120)f `tdQ
(over)
DOH-1555 (02/2004)