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Harke, Colton NEW YORK STATE DEPARTMENT OF HEALTH . Vital Records Section Burial - Transit Permit '' Name First Middle Last Sex 11 Colton ; ._. Berke Male • :. Date of Death ' Age`"_ If Veteran of U.S.Armed Forces, ' 03 / 20 / 2018 8 War or Dates No Place of Death Hospital, Institution or lc City,Town or Village City of Albany Street Address Albany Medical Center Hospital 14 Manner of Death M Natural Cause 0Accident 0Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation Medical Certifierr Name Title — Brady Bowen D.O. ri Address if AMCB, 43 New Scotland Ave., Albany, NY 12208 xr Death Certificate Filed District Number Register Number City,Town or Village City of Albany 0101 005 3 ti3Surlal Cemetery or Crematory Date IN >r 03 / 22 / 2018 ©Entombment-Address Pin®view Crematory � . Cremation Queensbury, New York >s Date Place Removed ❑Removal and/or Held and/or Address Hold 1Date Point of Q Transportation Shipment • i by Common Destination 46 Carrier I.E. Date Cemetery Address �xli 0 Disinterment Reinterment Date Cemetery Address it Permit Issued to Registration Number ft: Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main St., Warrensburg, NY 12885 �r qir� 44 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above X Address M • Permission is hereby granted to dispose of the human remains d= a e a ' dicated. �.s.� 1 Z\`2�� g . Date Issued Re tstrar of Vital Statistics +s (aigna4ms) t . District Number 0101 Place City of Albany , New York µ.1F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on; �:di Ill Date of Disposition '3)e31i t Place of Disposition e..t V.,., 4- (address) (section) /i (lot number) (grave number) Name of Sexton or Person in Char a of Premises •. U•. L ..)..--it _ Z 4 (geese print) - T. signature _ Title fr.,.. pr` (over) DOH-1555 (02/2004) 1