Furman, Mark 1' 11
NEW YORK STATE DEPARTMENT OF HEALTH 0
• Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
-- MARK R FURMAN Male
Date of Death Age If Veteran of U.S.Armed Forces,
May 30,2015 66 War or Dates 1968 1973
Place of Death /! Hospital, Institution or y�el r w I
• City, Town or Village > I` K Street Address A(bat4 I k vl �,t4 C-i r.
, Manner of Death® Undetermined Natural Cause Accident Homicide SuicidePending
Circumstances Investigation
`` Medical Certifier Name Title
r
Address
• VAMC ALBANY 113 HOLLAND AVE,ALBANY NEW YORK 12208
l - Death Certificate Filed District Number Register Number
City, Town or Village
OBurial Date l_ � ` 1� CemeWry or Crema qry
❑Entombment fj r �n'� U ` ei Vi2D C(CJ1 o,4 e)
Address p la
>:1 Cremation 2. 1 ( (,LLk t eit _ (,teFi lD CLAr /0 7
Date Place Removed
❑Removal
and/or and/or Held
Address
- Hold
,, < Date Point of
fug ETransportation Shipment
f7µ- by Common Destina:!on
Carrier
Disinterment Date Cemetery Address
4. Reinterment Date Cemetery Address
Permit Issued to 4 Registration tuber
Name of Funeral Home (jj-ni/G SS(o 1,, ' fii,(,i�xy4 f 0 0 3 6[7
Address
W0 2 //V`_` O i p 4 ie 5 ., -�sc Sp AJ
� ' Name of Funeral Firm Making Dispositi or to Whom Z 6CG
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above a i ar.atted.
-! Date Issued May 30,2015 Registrar of Vital Statistics James Arrington / % -
., (signature)
District Number Place VAMC ALBANY 113 HOLLAND AVE,ALBANY NEW YORK 12208
w
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
.,
:.��•wi Date of Disposition 6(2(/§" Place of Disposition ,,�0.... ( --
ti
• ,; (address)
fp •
: (section) (lotnumber/ (grave number)
i. ., Name of Sexton or Person in Ch ge of Premises A, hat-
s_ 4 ( ase print)
Signature Title ✓,
• (over)
DOH-1.555(02/2004)