Galster, Richard A
-4 _ # 5
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard Galster Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/02/2021 73 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
ILI
G Manner of Death Natural Cause 0 Accident El Homicide D Suicide ID Undetermined ❑Pending
W U Circumstances Investigation
ILI Medical Certifier Name Title
Paul Marra Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2716
ElBurial Date Cemetery,Crematory or Facility Name
11/04/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
- Hold Address
t/?
0
d Date Point of
to ❑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
S. Address
IL!
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/04/2021 Registrar of Vital Statistics Daniell?ScilTspie(Electronicall:y 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 permi
ZDate of Disposition )( � '( Place of Disposition „JL .. 1�.
2 /address)
W
CC
t!)
(section) of number) (grave number)
gName of Sexton or Person in Charge of Premi s t S s61.4�6fi
Z please riot)
W Signature Title 1004tt10,1
DOH-1555(07/18)p 1 of 2
0 " 5308
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 4