Albert, Raymond J 4t17c
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Raymond J.Albert Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/06/2021 80 Years War or Dates 1959-63
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 593 Pleasant Valley Road,Argyle Town,New York 12809
LLJ
p Manner of Death Natural Cause El Accident ❑Homicide 1=1 Suicide ❑Undetermined ❑Pending
lL Circumstances Investigation
W Medical Certifier Name Title
CI Anthony Petracca MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 68
❑Burial Date Cemetery,Crematory or Facility Name
11/08/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d 1-1 Date Point of
CD 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 M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/08/2021 Registrar of Vital Statistics ShelCey Mckcrnon(ECectronica1CySigned)
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit o •
Z
W Date of Disposition ���� Zt Place of Disposition 1 NIL— �`..
2 (address)
w
CC N
(section) nlot number) es (grave number)
AL
in Name of Sexton or Person in Charge of P mises r 1
Z i (pleas print)Signature Title L r
ie4Oft
DOH-1555(07/18)pi.of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of i " -d delivered on , 20
Pine View Cemetery Representing the funeral home named op b9 '11 permit
Official Funeral Directors Reg.or License# r,.' °