Hanna, Keith NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Y
`'i Name First Middle' . .;.* Last Sex
Keith Millard Hanna Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/24/2015 62 War or Dates No
l Place of Death Hospital, Institution
City,Town or Village City of Albany or Street Address Albany Medical Center
Wi' Manner of Death Natural ❑ Undetermined ❑ Pending
" ❑ Cause El Accident ❑ Homicide ❑ Suicide Circumstances Investigation
tiMedical Certifier Name Title
Michael Sikirica MA
Address
112 State St. Albany, NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1582
Date Cemetery or Crematory
❑ Burial 07/27/2015 Pine View Crematory
❑ Entombment Address
® Cremation 21 Quaker Rd. Queensbury, NY
Date Place Removed
Z Removal and/or Held
0 0 and/or Address
1.- Hold
CO
O Date Point of
a. Transportation Shipment
co 0 By Common G Carrier Destination
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
"` Name of Funeral Home Compassionate Funeral Care, Inc. 00364
-I Address
`f 402 Maple Ave. Saratoga Springs, NY 12866
45'%', Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
a' Address
La
a. Permission is hereby granted to dispose of the human rernaiins-dl ribed above as indicated.
Date 07/27/2015
A. Issued Registrar of\yital� `t.�« ; (sig� natures
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disp ed of in accordance with this permit on:
ii Date of Disposition 7 ^6 Place of Disposition +`ne thr�t,.) Cf-eliie4 grictisi
ILI (address)
LU
CO
It (section) (lot number) (grave number)
0
W Name of Sexton or Person in Charge of Premises G7 gr U e
(please print)
-�tea/ /►�J
Signature '4�-i's. �' Title CPC^�i d/'y IOC /"
/ (over)
DOH-1555 (02/2004)