Lohret, Michael frtiN
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section . f ...
Burial - Transit ermit
Name First ,r- Middle Last Sex
Michael S. Lohret Male
Date of Death Age If Veteran of U.S.Armed Forces,
August 15, 2012 48 War or Dates Yes
I—'; Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address Albany Medical Center
0 Manner of Death Natural Undetermined Pending
W ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
tJ Medical Certifier Name Title
W
G Jennifer DiMuro MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1567
Date Cemetery or Crematory
❑ Burial August 17, 2012 Pine View Crematory
0 Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z ❑ Removal and/or Held
and/or Address
Hold
N
0 Date Point of
d Transportation Shipment
co ❑ By Common Q Carrier Destination
❑ • Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01077
Address
123 Main Street, Argyle, NY 12809
FName of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
aAddress
W
EL Permission is hereby granted to dispose of the human remains described abo as,indicate
Date August 17, 2012 AA
Registrar of Vital Statistics ' � • /W0' /
Issued (signs re
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:
Z Date of Disposition 4'li-('L Place of Disposition ''kUk✓ City rl4..,,
w (address)
2
w
co
re (section) . (lot number) (grave number)
0
0
Z' Name of Sexton or Person in Charge of Premises Ar,s4Ll
W°'� (please print)
Signature 2Title CA45 M1Yra_
(over)
DOH-1555 (02/2004)