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Carney, John NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex John K CARNEY Male Date of Death Age If Veteran of U.S. Armed Forces, November 21 , 2012 93 War orDatesNov . 15 , 1943 - Dec . 25 , 1945 1 Place of Death Hospital, Institution or Z City, Town or Village Albany Street Address D V A M C Albany Manner of Death Lurvl Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined El❑Pending iii Circumstances Investigation tu Medical Certifier Name Title >I Kerry M. Barba MD Address 113 Holland Ave ,Albany , NY 12208 Death Certificate Filed Albany District Number 19 8 Register Number City, Town or Village 155 ❑Burial Date Cemetery or Crematory ❑Entombment it a3- act)a 70I .►P V, eu3 Cre, � M y Address ©Cremation q u,,e_e nS 6 u L(.4 N., Y. Date Place Removed E ❑Removal and/or Held and/or Address r= Hold to Date Point of ri 0 Transportation Shipment d by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox & Regan Funeral Home oiec i Address 11 Algonkin Street , Ticonderoga , NY 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address tr 1 . ` Permission is hereby granted to dispose of the human remains d crib a e as indicated. Date Issued 11/21/2 012 Registrar of Vital Statistics 6°4 (si nature) District Number 198 Place VAMC , Albany James I19. Arrington I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z 11/21/1 lEt Date of Disposition -Place of Disposition -Pifteu1A+.) CreArsetof iv•— (address) Itit IA CC (section) . (lot number) (grave number) a Name of Sexton or Person in Charge of Premises it _L-.. �St t- Z► (please print) ILI Signature Title Cbtnitiq. (over) DOH-1555 (02/2004)