Cross,LaDette 43145)7
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NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
LaDette Cross Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/31/2022 79 Years War or Dates Army
ZPlace of Death Hospital,Institution or
W City,Town or Village Albany Street Address St Peters Hospital
p Manner of Death ID Natural Cause ❑Accident Homicide Duicide Undetermined Pending
W
U Circumstances Investigation
0 Medical Certifier Name Title
Rabin Rai MD
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1274
BurialE
Date Cemetery,Crematory or Facility Name
06/04/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
DDonation
Removal Date Place Removed
H and/or and/or Held
- Hold Address
0
d. Date Point of
V)nTransportation
0 by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H. Remains are Shipped,If Other than Above
g Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/03/2022 Registrar of Vital Statistics Danie1leSGillespie(E(ectronicaftySigned)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition (p--G1—ZpZt_ Place of Disposition P; ,.i e (l €L�r.) (a- rest� ..
2 (address)
W
U)
CC (section) (lot nu ber) (grave number)
0 Name of Sexton or Person in Charge Premi es }f��/1�Ji�N� D�
Z (p ease print)
W Signature Title (1(E'e)-007 or
DOH-1555(o7/t8)p 1 of 2
0 .>A 11 6.F3
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing'the funeral home named on burial permit
Official Funeral Directors Reg. or License#