Runnalls, Glenn Szo
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
GLENN W. RUNNALLS Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 04,2014 67 War or Dates 1966 1968
Place of Death VAMC ALBANY NEW YORK Hospital, Institution or
City, Town or Village Street Address 113 HOLLAND AVE,ALBANY NEW YORK 12208
Manner of Death ❑ ❑ ❑ ❑Undetermined ❑Pending
Natural Cause Accident Homicide Suicide
Circumstances Investigation
Medical Certifier Name Title
DR.JING TANG M.D.
Address
VAMC ALBANY 113 HOLLAND AVE,ALBANY NEW YORK 12208
Death Certificate Filed District Number Register Number
City, "DIENBINCIPXX Albany 198 127
•
Date Ceme a or Cre atory
®Burial f r C
❑Entombment Address
►:�Crematioi -►Z - U Off/ /v
Date Place Removed / C
r-y ❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
•
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Hare 01130
Address
11 Lafayette St., Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued August 04,2014 Registrar of Vital Statistics James H. Arrington VSC
(signature)
District Number 198 Place VAMC ALBANY 113 HOLLAND AVE,ALBANY NEW YORK 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition gIILIIy Place of Disposition Volkvi
(address)
•
(section) (Iot_number) (grave number)
r • Name of Sexton or Person in Charge of Premises soli
(pl se print
Signature [:L Title CU ��
(over)
DOH-1555(02/2004)