Henry, Glenn 119, E
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
•
Name First Middle Last Sex
Glenn A. Henry Male
Date of Death Age If Veteran of U.S. Armed Forces,
07-08-2014 59 War or Dates 1973-75
1 - Place of Death Hospital, Institution or
Z City, Town or Village Albany Street Address 113 Holland Ave.,Albany,NY
Manner of Death 0 Natural Cause El Accident D Homicide p Suicide Undetermined El Pending
Circumstances Investigation
la Medical Certifier Name Ishtpreet Uppal Title
P PPaMD
Address
113 Holland Ave.,Albany,NY 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 198 120
['Burial DI.), Cemetery or Crematory
(y - a0 1 q 4 LL v- -) /- cF,�c%
['Entombment ,address
ZCrematiori 2_1 0_,_,Je...__. P`0. a_ 1a~4-0, '"�"
Date Place Removed
Z Removal and/or Held
❑and/or Address
fR
Hold
o Date Point of
Di El Transportation Shipment
C by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home '�' C5 ' "-1"'''`R - 't-u^--'-�-"'- k"4", "--'<-__. 0 1 0 7 cf -
Address
461 Name of Funeral Firm Making Disposition or to Whom
loio Remains are Shipped, If Other than Above
" Address
tr
to ,•'
fl` Permission is hereby granted to dispose of the human re i s descr b7i a d.
lig Date Issued 07-08-14 Registrar of Vital Statistic J s Arr ngto ,Manager SC
(signature)
District Number 198 PlaceDVAMC, Albany,NY
IH 1r
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i Date of Disposition —HU (' Place of Disposition Zvi/two o Cw r►r--
(address)
fil
U
CC (section) lot number) (grave number)
Name of Sexton or Person in arge of Premises t lit,
St'�'^
Z (pse print)
til Signature
_.. Title CII $f ak
(over)
DOH-1555 (02/2004)