Jones, Christopher Michael NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records *V-„ '
Name First Middle Last Sex
Christoper Michael Jones Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/07/2022 43 Years War or Dates
F— Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address Albany Medical Center Hospital
0 Manner of Death ❑Natural Cause Accident ❑Homicide Suicide FlUndetermined ❑Pending
WI
V Circumstances Investigation
W Medical Certifier Name Title
0
Timothy Cavanaugh Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1839
Burial Date Cemetery,Crematory or.Facility Name
08/10/2022 Pine View Crematory
Entombment Address
IICremation Queensbury Town,New York
Donation
ZRemoval Date Place Removed
and/or and/or Held
t•- Hold Address
N
0
O. Date Point of
O OTransportation
p by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward, New York 12828
Name of Funeral Firm Making Disposition or to Whom
IH Remains are Shipped,If Other than Above
,_• Address
Ilt
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n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2022 Registrar of Vital Statistics Dan1elTe S Gillespie(ETectronica1Ty Signed)
(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:
Date of Disposition gill 12Z Place of Disposition 4 1.4{V� Cam_
W
2 (address)
W
a (section) (lot amber) (grave number)
8 Name of Sexton or Person in Charge o Premises li,n lL S'"`a
2 (ple4e print)
ILI
Signature Title V 6(7 w7Vit
DOH-1555(07/18)p 1 of 2
f y
f'
1 Public Health Law Sec. 4145(2b)
Receipt
r
1 Human remains of delivered on , 20 Q�
1
1
./ i`'
Pine View Cemetery Representing the funeral home named on bur.a1 permit
Official Funeral Directors Reg.or License# 1 i 4is, / 1E
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