Stein Jr, Albert w )
NEW YORK STATE DEPARTMENT OF HEALTH 6 3
Vital Records Section Burial - Transit Permit
▪ Name First Middle Last Sex
Albert Frank Stein,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 18, 2015 81 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
�i Circumstances Investigation
Medical Certifier Name Title
gi Howard Silverberg Dr.
Address
318 Broadway,Fort Edward,NY 12828
Death Certificate Filed District Number Rr�N tuber
.
City, Town or Village Glens Falls,
NY 5601
❑Burial Date Cemetery or Crematory
❑Entombment July 21, 2015 Pine View Crematorium
Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
O Date Point of
coTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
'::r: Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Pi
▪ Permission is hereby granted to dispose of the human r(mains d cribed ab ve as indic•ted.
▪ Date Issued i Registrar of Vital Statistics ef(....e.-e--A-1 a,/ _ G _
(signature)
▪ District Number 5 U/ Place Glens Falls,NY
I certify that the remains of the decedent identified above were isposed of in accordance with this permit on:
W Date of Disposition llZNltc Place of Disposition 'tom , (1
W (address)
CO
d' (section) lot•nu ber) (grave number)
o Name of Sexton or Person in Ch rge of Premises t'i �^% � ^0,or
Z (ple se print) �71y
W - /IYj 1"'Signature Title L
(over)
DOH-1555(02/2004)