Dingman, James ifs
NEW YORK STATE DEPARTMENT OF HEALTH t
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James F. Dingman Male
Date of Death Age If Veteran of U.S.Armed Forces,
_' 12/31/2014 64 War or Dates No
I— Place of Death Hospital, Institution
Z'' City , Town or Village City of Albany or Street Address St. Peter's Hospital
0 Manner of Death Natural ❑ Undetermined ❑ Pending
°V ® Cause ❑ Accident ❑ Homicide ❑ Suicide Circumstances Investigation
Medical Certifier Name Title
LLI
p'' Niloo M. Edwards MD
Address
319 S. Manning Blvd. Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 2504
Date Cemetery or Crematory
El Burial 01/02/2015 Pine View Crematory
El Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
Hold
Cl)
Q Date Point of
a Transportation Shipment
Cl) El By Common
p Carrier Destination
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
El Reinterment
Permit Issued To Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
Address
24 Church St. Lake Luzerne, NY 12846
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ce
0- Permission is hereby granted to dispose of the human remain 'bed above as indica
Date 01/02/2015 Registrar of Vital istics
Issued ignature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance`' with this permit on:
Z Date of Disposition (/i j/y {'''�Y��Place of Disposition 64Cre*-.."
W (address)
w
cn
re (section) of number) (grave number)
O
ALSL
Name of Sexton or Person in Charge of Premises � G'�
(please print)
Signature Title fiii trpfe.
(over)
DOH-1555 (02/2004)