Heinrich, George 01/29/2018 08:47 5183773446 LIGHTS FUNERAL HOME PAGE 01/01
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit H lw
Vital Records Section
Name First Middle Last Sex
Nk i GEORGE ALBERT HEINRICH _ • MALE
Date of Death Age If Veteran of U.S.Armed Forces;
i 01/25/2018 War or Dates
Place of Death Hospital,institution
City,Town or village City of Albany or Street Address ALBANY MEDICAL CENTER
imi Manner of Death Natural Undetermined ❑ Pending
❑ Cause El Accident ❑ Homicide ❑ ❑
d
at, Suicide Circumstances Investigation
01 Medical Certifier Name Title
P ANDREW DEPOO MD
Address
43 NEW SCOTLAND AVE.ALBANY NY 12208
irk Death Certificate Filed District Number Register Number
e b City,Town or Village City of Albany 101 0194
':i I:]Buried
Date Cemetery or Crematory •
` ID Entombment 01/29/2018 PINE VIEW CREMATORIUM
Cremation Address .
QUEENSBURY, NY
Date . Place Removed
Removal and/or Held
CR ❑ and/or Address
Hold
Date • Point of
Transportation' ` ❑ By Common Shipment
Q Carrier Destination
ID Disinterment
Date Cemetery Address
Date Cemetery Address
4 ❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home REGAN & DENNY FUNERAL HOME 01444
Address
'' 94 SARATOGA AVE. SOUTH GLENS FALLS, NY 12803
r Name of Funeral Firm Making Disposition or to Whom
••• Remains are Shipped,If Other than Above
Address u
•
Wr Permission is hereby granted to dispose of the human remains described above as indicated.
s 17
p , Date .t i�•t
1.:?b: Issued Registrar of Vital Statistics •
;� ' (signature)
p. . 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 t/-'i i.ig Place of Disposition _ -RAJ., L.
]LY (address)
in
IC
.o (section) /(Iot numbery (grave number)
zName of Sexton or Person in Charge of Premises kil ()�-+Gt
�' (please print) I
Signature G Title /k` f1•rag,
(over)
DOH-1555(02/2004) .