Viele, Eric John I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Eric John Viele Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/21/2022 59 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address St Peters Hospital
pManner of Death ❑X Natural Cause ❑Accident Homicide El SuicideEi Undetermined Pending
C Circumstances Investigation
W Medical Certifier Name Title
Zothanmawii Khiangte MD
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0552
❑Burial Date Cemetery,Crematory or Facility Name
02/25/2022 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
ElDonation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
d Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
a Address
W
11' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/25/2022 Registrar of Vital Statistics Daniell?S0/kirk. Electronicaf Sfgned
(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 Date of Disposition a/p..2p;Zx Place of Disposition f AJP V e ) rr t
tu
2 (address)
W
CC N (section) (lot number) (grave number)
GName of Sexton or Person in Charg f Premises; /7//�U'1�� � �
Z (please print)
W Signature ; /'! Title �jQ�J� ��
DOH-1555(o7/18)p t of 2 V
01 582e''
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#