Coon, John t.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
JOHN J COON Male
Date of Death Age If Veteran of U.S.Armed Forces,
October 30,2016 73 War or Dates 11-15-1961 03-07-1966
Place of Death Albany Hospital, Institution or
City, Town or Village Street Address DVAMC 113 Holland Avenue Albany, NY 12208
Manner of Death❑k Natural Cause Accident El Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
MD.
Address
113 Holland Avenue Albany, NY 12208
Death Certificate Filed Alban District Number Register Number
City, Town or Village y 0198
-QBurial Date Cemetery j'or Cre tory
['Entombment Address
1 Lai6 Pines V;aw Litma�ciu w►
Address
1Cremation Luctic_., , :.r , frt)
Date Plade Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
0
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home etIRIMP ruijkAeli F7bf1
Address
b �1ITO Sr f lu450 N r4Lr N 1767g,
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 iicated.
Date Issued October 30,2016 Registrar of Vital Statistics Jaat?s
(signature)
District Number 0198 Place DVAMC, 113 Holland Avenue, Albany, New York 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Ir/i /�, Place of Disposition u Ct-'
►n► It i.....
(address)
(section) 19t number) (grave number)
Name of Sexton or Person in Charge of PremisesCa 1zplr r St�N��ifi
(pleaselprint)
Signature 4- Title (tVE►�D9 4.
(over)
DOH-1555 (02/2004)
COON '
LF
Owner
John & Cynthia Coon TOIL) CV' ON
Address 60 Lax chuKK N`3 Plot
Abenaki
Phone # Lot #
lz.9 1 Qct o 8 C
Deed # Date
2917 10/2/1 R
Cost Foundatio N
1 , 050 \.
Location Bounded on the North by West, South by LeRoux
East by Vacant and West by VanVranken
Remarks
John Coon lot and Shirley West lot, switched in May 2002.
See attached letter if there are any questions.
Record of Interments
1 A) John Coon II 6/10/16 Crem 6
2 7
3 , , • '7. 9. ao / 8
O//c< v /1igricL l ' 7- a- aUa/
4 9
5 10
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COON �!
NAME John Coon II Age: 4 3
Lot Owner: John & Cynthia Coon
Lot# 8C, Abenaki Grave# 1
Case: Marble Urn
Died: 6/3/2 01 6 Interred: 6/1 0/1 6
Funeral Home: Maynard Baker
Cemetery: Pine View