Stearns, Richard it it ii 31
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section BurialUrIaI - Transit Permit
Name First Middle Last Sex
RICHARD H. STEARNS MALE
Date of Death Age If Veteran of U.S.Armed Forces,
06/24/2014 71 War or Dates
I— Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER HOSPITAL
ci Manner of Death Natural ❑ Undetermined ❑ Pending
ILI ❑ Cause ® Accident ❑ Homicide ❑ Suicide Circumstances Investigation
W' Medical Certifier Name Title
G JEFFREY D. HUBBARD M.D.
Address
112 STATE ST. ALBANY, NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1229
Date Cemetery or Crematory
❑ Burial 06/26/2014 PINEVIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
P' Hold
CO
Q Date Point of
EL Transportation Shipment
t/) ❑ By Common Destination
p Carrier
El Disinterment
Cemetery Address
Disinterment
Date Cemetery Address
❑
Reinterment
Permit Issued To Registration Number
Name of Funeral Home BREWER FUNERAL HOME, INC. 00211
Address
24 CHURCH ST. P.O. BOX 500 LAKE LUZERNE, NY 12845
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
W
0- Permission is hereby granted to dispose of the human remains des 'bed above as indicated.
Date 06/26/2014 f>
Issued Registrar of Vital Statistics )
nature
District Number 101 Place City of Albany, NY
I certify that the remains of the
decedent identified above were disposed of in accordance withthis permit on:
F-, Date of Disposition 6 ill/f�{ Place of Disposition 'l o4 K`) ��^ o i_
LU (address)
LU
O (section) (lo number) Cvigif
(grave number)
w af,s(• Name of Sexton or Person in Charge of Premises 'rit-- �Ji
(please print) g
ii,,..._ /1-
Signature
Title CIS-''i it y
(over)
DOH-1555 (02/2004)