Sutphin Jr., Wilbert Silas NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Wilbert Silas Sutphin Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/24/2020 54 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
WW Manner of Death
Natural Cause El Accident 1:1Homicide El Suicide El Undetermined El Pending
V Circumstances Investigation
U.I Medical Certifier Name Title
Jared Sweeney
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2888
ElBurial Date Cemetery,Crematory or Facility Name
12/29/2020 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
0 Donation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a- Date Point of
f!) Li Transportation
p 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
H Remains are Shipped,If Other than Above
"E" Address
CC
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/28/2020 Registrar of Vital Statistics 2JanielkSy'illerpiegkctronical5Signea9
(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 ermit on:
I—
Z Date of Disposition ( / /ZO Place of Disposition ui
P 1—4... 4--.
2 (address)
W
U)
CC (section) d (/ot number) (grave number)
Name of Sexton or Person in Cha Premisesf.. U c��N►44
Z (pt /1
se print)
W Signature Title &Om if PP
DOH-1555(07/18)p 1 of 2
0181364
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#