Irish, Hogan Damien i t I1/
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Per It
Bureau of Vital Records
Name First Middle Last Sex
Hogan Damien Irish _ Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/05/2020 33 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
`p Manner of Death 1=1 Natural Cause X❑Accident El Homicide ElSuicide El Undetermined 1=1 Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Paul Marra Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101
Burial Date Cemetery,Crematory or Facility Name
11/09/2020 Pine View Crematory
ElEntombment Address
Cremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
H
N Hold Address
0
11- 1-1 Date Point of
co ❑Transportation
Q by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
"S Address
LE
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2020 Registrar of Vital Statistics rDanie&S0illerpie(Electronicai /Signed)
(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 o :
Z Date of Disposition 1` iQ 20 Place of Disposition.. G^�
l (address)
W
CC (section) Ilot number (grave number)
O Name of Sexton or Person in Charge of remises (1 �'t L q-Ar
Z (pi se prin
W Signature Title t It O
DOH-1555(07/t8)p 1 of 2
Public Health Law Sec. 4145(2b) 01 41 83
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#