Gonyo, Larry Harold 10F -#8g7
NEWYORKSTATE DEPARTMENT OFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Larry Herold Gonyo Male
Date of Death Age If Veteran of U.S.Armed Forces,
05102/2022 71 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
Man ner of Death El Natural Cause ❑Accident ElHomicide Suicide Undetermined ❑Pending
W Circumstances Investigation
WQ Medical Certifier Name Title
Mohammad Hamza MD •
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed city Of Albany District Number Register Number
tit ,Town or Ville 0101 1049
Burial Date Cemetery,Crematory or Facility Name
05/09/2022 Pine View Crematory
ntombment Address
EiCremation Queensbury Town,New York
DDon ation
❑Removal Date Place Removed
p and/or and/or Held
to Hold Address
ransportation Date Point of
by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
DReinterment
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
a Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/05 22 Registrar of Vital Statistics ,DlorrislPsSca.s-isglcttvmicaQySigmsr0
(signature)
District Number 0101 Place city ot Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this penniton:
inDate of Disposition 5110 f 27.. Place of Disposition Frn-t.V� 'Or.
2 /eddhess/
W
In
CC (section) (lot number) C (gre Ne number)
8 Name of Sexton or Person in Charge f Premises 4,„41...... -�ri,.r(i'z ese print)
Signature �-�t ll�.� Title �lZElri0510
DOH 1555(07/18)pi of 2
i
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#