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Stevenson, Troy Blair # 4b . NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Troy Blair Stevenson Male Date of Death Age If Veteran of U.S.Armed Forces, 01/19/2022 60 Years War or Dates F- Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital 'p Manner of Death © Natural Cause El Accident Homicide Suicide Undetermined Pending U Circumstances Investigation LU Medical Certifier Name Title CI Fatima Mahmood Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0162 ElBurial ' Date Cemetery,Crematory or Facility Name • 01/20/2022 Pine View Crematorium C Entombment o Address . jCremation ' Queensbury Town, New York EiDonation j • . Z Date Place Removed Q 0 Removal and/or and/or Held H Hold I Address 0 ta/) Transportation Date Point of 8 by Common Shipment Carrier Destination Disinterment Date Cemetery Address IDReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC UU a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2022 Registrar of Vital Statistics Danielle Gillespie(EkctronicallySigned) (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 UJ Date of Disposition /Zr 17Z Place of Disposition VI ' � .fir �d �.(address) W CC (sea/on) (lot number) (grave number) 71 g Name of Sexton or Person in Charge of Premi s 4c ^itt Z / ( ase print) W r,.K/vl Signature Title DOH-1555(07/18)p 1 of 2 r"s `4 Y /- aw r�"Q# Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#