Brown, Gary 1_4' 7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
GARY B BROWN Male
Date of Death Age If Veteran of U.S.Armed Forces,
April 05,2016 71 War or Dates 1963 1966
Place of Death VAMC ALBANY NEW YORRK Hospital, Institution or
City, Town or Village Street Address 113 HOLLAND AVE ALBANY NEW YORK 12208
Manner of Death Natural Cause ❑Accident ❑Homicide p Suicide ri❑Undetermined El Pending
Circumstances Investigation
Medical Certifier Name • Title
Margaret Pollard MD
Address
VAMC ALBANY 113 HOLLAND AVE,ALBANY NEW YORK 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany, NY 198 040
❑Burial Date Cemetery or Crematory
April 7, 2016 Pine View Crematory
['Entombment Address
®Cremation Quaker Rd. Queensbury, NY
Date Place Removed
ri❑Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral HOme 01 443
Address 53 Quaker Rd. Queensbury, NY 12804
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 i de r' e a dicated.
Date Issued 04/05/2016 Registrar of Vital Statisti� n
(sign re)
District Number 198 Place VAMC ALBANY 113 HOLLAND AVE.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 q / (i6 Place of Disposition fuUu_I CrrGnnq ccp-v
(address)
(section) /j (lot number (grave number)
Name of Sexton or Person in Charge of P emises G '�rgi
lease print)
Signature Title < 1tT
(over)
DOH-1555(02/2004)