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Goggin, Roland E.
411y0 NEWYORKSTATEDEPARTMENTOFHEALTH - Y Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Roland E Goggin Male Date of Death Age If Veteran of U.S.Armed Forces, 11/05/2021 81 Years War or Dates H. Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital W p Manner of Death ©Natural Cause Accident Homicide ❑Suicide ❑Undetermined ❑Pending W V Circumstances Investigation ClU,I Medical Certifier Name Title David Stillman Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2735 11 Burial Date Cemetery,Crematory or Facility Name 11/08/2021 Pineview Crematory El Entombment Address EiCremation Queensbury Town,New York EDDonation 4s 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 a. Date Point of co ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom l-- Remains are Shipped,If Other than Above a Address Q W 11 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically 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: I— WDate of Disposition i i (9 1 Zl Place of Disposition '4(N L— „ -.rt.-- 2 (address) W CC (section) (lot numberd-- (grave number) aName of Sexton or Person in Charge remises ��r) 1�'n�l�"� Z / lease print/ W Signature Title le44710(VA( DOH-1555(07/18)p 1 of 2 ,) 1,5 3 ',2) 7 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#