Cole Jr, Harold NEW YORK STATE DEPARTMENT OF HEALTH 13Sr-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harold H . Cole JR Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/29/2014 63 WarorDates 1/14/1969-11/03/ 19 / 1
-y Place of Death Hospital, Institution or
City, Town or Village Albany Street Address113 Holland Ave . ,Albany ,N Y
WManner of Death 0 Natural Cause Li Accident 0 Homicide 0 Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Ishtpreet Uppal MD
Address
113 Holland Ave . ,Albany ,NY 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 198 092
❑Burial Date Ce tery or Crematory
KI lie. tie-ea) c-eeirai-a/el
❑Entombment Addres �'
UrCremation 011 Ci(,60,1 Dad/ Q u eei sbeL&J ,Al)) /.6?go
Date Place Removed
Removal and/or Held
.... and/or Address
t Hold
IA
0 Date Point of
i ❑Transportation Shipment
t1�
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Homesionate Funeral Care 00364
Address
402 Maple Avenue, Saratoga Springs, New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
l
to
` Permission is hereby granted to dispose of the human rem • e cr d above as indicated.
Arringt
Date Issued 05/29/14 Registrar of Vital Statistics Janes
(signature)
ED District Number 198 Place DVAMC 113 Holland Avenue, Albany, New York 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition to bill Place of Disposition .�;,�,I e,(.r,�.40r,.._.
(address)
W
tfl
11. (section) (lot nu er) (grave number)
Q Name of Sexton or Perso in Charge of Premises ++i�'
(please print)
W.
Signature G Title C �
(over)
DOH-1555 (02/2004)