Hoffman, Arthur NEW YORK STATE DEPARTMENT OF HEALTH , , Burial - Transit Pe
t.-� rmit
Vital Records Section
Name First Middle ' Last Sex
Arthur L. Hoffman Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/24/2013 23 War or Dates No
I— Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address Albany Medical Center Hospital
pManner of Death Natural Undetermined Pending
W ® Cause ❑ Accident E Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
W' Medical Certifier Name Title
Ca John Keenan Coroner
Address
112 State Street Albany, NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 858
Date Cemetery or Crematory
0 Burial 05/01/2013 Pine View Crematorium
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
0 0 and/or Address
Hold
U)
O Date Point of
a Transportation Shipment
Cl) ❑ By Common
p Carrier Destination
ElDate Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
9 Pine Street Chestertown, NY 12817
H' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ce
LU
a- Permission is hereby granted to dispose of the human remains descri d above as indicate .
Date 05/01/2013 Registrar of Vital Statistics �� (s
Issued signature)
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:
_ /a
li Date of Disposition 0 6 Place of Disposition "Ustv.i (1K , r..
to (address)
2I'rr
w
Cl)
IX (section) (lot number `' (grave number)
0
Ci
Z Name of Sexton or Person in Charge of Premises An614k
w:. (please print)
Signature ArIL Title CbtalO't(L
(over)
DOH-1555 (02/2004)