Sullivan, James NEW YORK STATE DEPARTMENT OF HEALTH 0
Vital Records Section Burial - Transit Permit
Name First MiddleLast Sex
JAMES F SULLIVAN MALE
Date of Death Age If Veteran of U.S.Armed Forces,
01/30/2012 60 War or Dates 1970-72
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
CU ® ❑ Accident ❑ Homicide ❑ Suicide ❑
CauseCircumstances Investigation
Medical Certifier Name Title
ILI
C) TRAVIS ARNOLD-LLOYD MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 208
Date Cemetery or Crematory
❑ Burial 02/01/2012 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
I Hold
Cl)
aTransportation Date Point of
NI ID By Common Shipment
p Carrier Destination
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home REGAN & DENNY F.H. 01444
Address
94 SARATOGA AVE., S. GLENS FALLS NY 12803
F- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ZAddress
w
a Permission is hereby granted to dispose of the human remains de cribed above as i icated.
Date 01/31/2012 k{Q \� ,s,
Issued Registrar of Vital Statistics ..-� q(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:
Z Date of Disposition 2/3 AL Place of Disposition 'f `nc t/1J 611. 1 j0riiM.
ILI (address)
w
N'
CL (section) (lot num r) (grave number)
0c.
WName of Sexton or Person in Charge of Premises 4 r%si-.94f eg40-
L
(please print) �1
Signature Title CeltPrit)r
AU'
(over)
DOH-1555 (02/2004)