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Cocheo, Jack NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Jack C. Cocheo Male Date of Death Age If Veteran of U.S. Armed Forces, Oct. 22, 1995 39 War or Dates No Place of Death Hospital, Institution or City, Town or Village City of Albany Street Address Albany Medical Center Hosp. Manner of Death©Natural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation � Medical Certifier Name Title Seth MD Address ANILA Albany Medical Center Hosp. Albany, N.Y. 12208 Death Certificate Filed District Number Register Nura$�r8 XX City, Town or Villagigit y of Albany 101 Date Cemetery or Crematory ❑Burial Oct. 25, 1995 Pine View Crematory Address ®Cremation eensb N.Y. Date Place Removed 8 Removal and/or Held -• and/or Address Hold Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home William J. Burke & Sons F.H. 00267 Address 628 No. Broadway Saratoga Springs, N.Y. 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address >[ Permission is hereby granted to dispose of the human re!7s described above as indicated. t. 25, 1995 / Date Issued Registrar of Vital Statistics (signature) District Number 101 Place City of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition o� Place of Disposition �,� Lb .. (address) N > (section) (lot number) > (grave number) 0 Name of Sexton or Person in Charge of Premises ?7y /�/�Tf// ,Q`/'� (please print) f Signature Title r DOH-1555 (10/89) p. 1 of 2 VS-61