Austin, John ' h ., ,,
NEW YORK STATE DEPARTMENT OF HEALTH Z46
Vital Records Section w, Burial - Transit Permit
Name First Middle Last Sex
John E. Austin Male
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 03 / 2015 77 War or Dates No
14 Place of Death Hospital, Institution or
it City, Town or Village City of Albany Street Address Albany Medical Center Hospital
Q Manner of Death®Natural Cause Accident 0 Homicide 0 Suicide Undetermined ❑Pending
tit Circumstances Investigation
al Medical Certifier Name Title
i9 Vin Patil M.D.
Address
< i AWE, 43 New Scotland Ave, Albany, NY 12208
Death Certificate Filed District Number Register Number
"`' City of Albany 0101
City,Town or Village 7(00
il D8urial Date Cemetery or Crematory
a 04 / 07 / 2015 Pineview Crematory
w: Q Entombmentffi Address
tilil 1g Cremation Queensbur
y, New York
iiiiil Date Place Removed
Z Removal and/or Held
tii.❑and/or Address
N Hold
0 Date Point of
6❑Transportation Shipment
0 by Common Destination
s Carrier
Si Date Cemetery Address
•:<<,Q Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
`'r Alexander Funeral Home, Inc. 00037
4:x Name of Funeral Home
4.v.`
tg Address
cats
3809 Main Street, Warrensburg, NY 12885
w:€:
t Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
CC
Ii#
Ai
Permission is hereby granted to dispose of the emains descri ed abov s ndicated.
2 Date Issued 4/6/2015 Registrar of Vit tistics
s::• signature)
District Number 0101 Place city of Albany , New York
•'" I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
U
• Date of Disposition qi`tiJ K' Place of Disposition ,,�, .,,� Cat,,....
2 (address)
M. (section) (lott umber) (grave number)
O Name of Sexton or Person iri Charge of Premises - G"vr^
z • (please print) •
Signature ' 4 Title -:#1,104_
•
(over)
DOH-1555 (02/2004)