Gilboy, Justin /23d
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Justin Gilboy Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/19/2020 39 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
in Manner of Death ❑Natural Cause X❑Accident El Homicide p Suicide I=1 Undetermined Pending
W U Circumstances Investigation
W Medical Certifier Name Title
O Timothy Cavanaugh Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2519
ElBurial Date Cemetery,Crematory or Facility Name
11/23/2020 Pine View Crematory
ElEntombment Address
lCremation Queensbury Town,New York
❑Donation
ZO El Removal Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
U) 11 Transportation Shipment
3 by Common
Carrier Destination
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/23/2020 Registrar of Vital Statistics Dane&5 yilksprt gYectronicall Vned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition I//jS/70 Place of Disposition Z tbs.-LLI
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2 (address)
W
N (section) (lot number) (grave number)
g Name of Sexton or Person in Charge Premises
Z (ple a print)
lL Signature Title ` +
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