Runewicz, Stephen Michael -d 5z I
NEW YORK STATE DEPARTMENT OF HEALTH
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Bureau of Vital Records Burial - Transit Permit
t Name First Middle
Last Sex
., Stephen Michael Runewicz Male
Date of Death Age if Veteran of U.S.Armed Forces,
0522/2022 56 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death
a
W Natural Cause ❑Accident Homicide ❑Suicide Undetermined ❑Pending
U Circumstances Investigation
G Medical Certifier Name Title
John Shultz MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed city Of Albany District Number Register Number
C. ,Town or Vitt a 0101 1503
Burial Date Cemetery,Crematory or Facility Name
07/012022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
goRemoval Date Place Removed
P and/or and/or Held
N Hold Address
0
0. Date Point of
Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
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
t'— Remains are Shipped,If Other than Above
2 Address
IC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/30/2022 Registrar of Vital Statistics DamaiSgiapu(4ctmraca/y.Snd)
(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—
Z Date of Disposition /-22Zt- Place of Disposition 69 )}p i/,tPJ 6— A4 P---
1.11
(addrest/
W
N (section) (lot n m)erl (grave number)
ar
8 Name of Sexton or Person in Charge of remises '14116�✓A 1410 c Cs
z (please print)
W Signature 11 Title f0{�
DOH-1555(07/18)p 1 of 2
8
Public Health Law Sec. 4145(2b)
Receipt
Human remains of t i„, delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#