McGriff, Sham-el Nasir @, -4- 3 1(
NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Shanre1 Nasir McGdff Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/13/2022 4 Days War or Dates
H Place of Death Hospital.Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
SMan nerof Death Ei Natural Cause Accident El Homicide Suicide Undetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
G Meredith Monaco-brown MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed city y District Number Register Number
Cit E,Town or Village 0101 0963
Burial Date Cemetery,Crematory or Facility Name
Addres022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
pz Removal Date Place Removed
and/or and/or Held
N Hold Address
O
O. Date Point of
U)['Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
ElReinterment
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
I— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04252022 Registrar of Vital Statistics Q.hits!&Sgtl�espis(TSctmmcaQ3'SrA4
(signalure)
District Number 0101 Place City Of Albany
1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition q(7s-i'll- Place of Disposition ..Rkl_ L
2 (address/
W
IX (section) (lot number) `\ (grave number)
8 Name of Sexton or Person in Charge of Pre ises to nl 1 10
z (p/eYse print/
inl� el
'F�►w �'�
Signature Title
DOH-1555(o7/t8)p 1 of 2
0 4 ,
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#