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Vonderheide, James A NEW YORK STATE DEPARTMENT OF HEALTH ` • 5°N Vital Records Section Burial - Transit Permit Name First Middle Last Sex JAMES A VONDERHEIDE Male Date of Death Age If Veteran of U.S. Armed Forces, October 24,2021 82 War or Dates 11/16/1961 -09/08/1962 E.- Place of Death Hospital, Institution or W City, Town or Village Albany Street Address DVAMC 113 Holland Avenue Albany, NY 12208 W Manner of Death©Natural Cause El Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title a JOHN IRVING LESO MD. Address 113 Holland Avenue Albany, NY 12208 Death Certificate Filed Alban District Number Register Number City, Town or Village y 0198 " ❑Burial Date l Cemetery or Cremato ❑Entombment l vl /Zet) A� V ie� Address CremationeC� c.ts.3 wi Date dace Removed Z Removal and/or Held F* and/or Address Hold 0 Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home ,41t _ �Cl/ jF)& M ,C O6'/ (.' )7 Address Name of Funeral Firm Making Disposition or to Mom it Remains are Shipped, If Other than Above IAddress W Permission is hereby granted to dispose of the human r ain les ' ed abov ,as'tFdicated. Date Issued October 24,2021 Registrar of Vital Statistic s H. ' gton (signature) District Number 0198 Place DVAMC, 113 Holland Avenue, Albany, New York 12208 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 / iii Date of Disposition/0—Z2- / Place of Disposition Y[�r' ,e (,�:-aC _' cre,114, 1,4 (address) (section) (lot num r) (grave number) pName of Sexton or Pers in Ch e of Premises � ��D.-,(� / please print) Signature / Title ©r�4-7� (over) DOH-1555 (02/2004) allbr