Smail, James NEW YORK STATE DEPARTMENT OF HEALTH ` 315-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
de James Donald Smail Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/23/2015 71 War or Dates No
F-- Place of Death Hospital, Institution
„ City ,Town or Village City of Albany or Street Address St. Peter's Hospice 315 S. Manning Blvd.
caManner of Death Natural Undetermined Pending
W ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances Investigation
W Medical Certifier Name Title
Thea Dalfino MD
Address
315 S. Manning Blvd. Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1562
Date Cemetery or Crematory
❑ Burial 07/24/2015 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
5 ❑ and/or Address
f_ Hold
CO
Date Point of
a Transportation Shipment
Cl)', ❑ By Common G Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main St. So. Glens Falls, NY
Name of Funeral Firm Making Disposition or to Whom
""` Remains are Shipped, If Other than Above
„d Address
w'.
Permission is hereby granted to dispose of the human rem ' escribed above as indicated.
Date 07/24/2015
Registrar of Vita
I`; Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were(re disposed of in accordance with this permit on:
Z Date of Disposition 1)-,)')—t,S' Place of Disposition f i'n.e J.'ecii C-'447
UI (address)
w
co
w' (section) (lot number) (grave number)
0
G /�
Z Name of Sexton or Person in Charge of Premises emptily ,r1P[I@
W ��„ (please print)
Signature Title Cren,c40n, 4SS •
(over)
DOH-1555 (02/2004)