Pontiff, Paul Edward 1341
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul Edward Pontiff Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/05/2021 91 Years War or Dates Korea
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
W Manner of Death Undetermined 1=1Pending
W ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide
Circumstances Investigation
W Medical Certifier Name Title
Zachary Landau DO
Address
43 New Scotland Ave,Albany, New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village 'Albany 0101 2468
❑Burial Date Cemetery,Crematory or Facility Name
10/06/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
O• ElRemoval Date Place Removed
and/or and/or Held
H Hold Address
O
d Date Point of
❑
U) Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
❑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
1— Remains are Shipped,If Other than Above
5 Address
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/06/2021 Registrar of Vital Statistics Dania&S j'illespie(Ekctronrcall5 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 on:
Z Date of Disposition /�1.2.OL 1 Place of Disposition tie 0 1 J (',---44� .t'-�(
w (address))
W
Cr)
CC (section) ‘--Z� (lot number) (grave number)
0 Name of Sexton or Person in Ch a of Premis I�tO� '
Z (please print)
W
Signature Title Ot`�T>
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) "' "`�`
Receipt
Human remains of ' ' delivered on , 20
r
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#