Tanzer, Cole Elliot Rhoads SSrI
LOF P
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Cole Elliot Rhoads Tanzer Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/26/2022 8 Days War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
ILI
p Manner of Death El Natural Cause Accident []Homicide []Suicide Undetermined ❑Pending
W Circumstances Investigation
V
Ili Medical Certifier Name Title
CI Gina Geis MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1724
HBurial Date Cemetery,Crematory or Facility Name
07/29/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F Hold Address
N
0
O. Date Point of
N)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
g Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/28/2022 Registrar of Vital Statistics Danielle S Gillespie(Electronically 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:
Z ? A)e tr
IJJ Date of Disposition ]-a9,2aL Place of Disposition t e C-/- 'j 4�a f�
2 (address
W
N CC (section) (19t mauler) (grave number)
!/
CName of Sexton or Person in Charge f Premises A7�D/✓� �
Z (please print)
UJ Signature 4 / Title UP��I/
DOH-1555(07/18)p tar 2
ri
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#