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St. Louis, Brett P . 7 LF) It�d0 NEW YORK STATE DEPARTMENT OF HEALTH � / Vital Records Section Burial - Transit Permit Name First Middle Last Sex Brett P. St. Louis Male Date of Death Age If Veteran of U.S. Armed Forces, November 06,2022 66 War or Dates 3/13/1973-5/16/1977 Place of Death Hospital, Institution or City, Town or Village Albany Street Address DVAMC 113 Holland Avenue Albany,NY 12208 Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title CM Dong Kim MD r Address ,, 113 Holland Avenue Albany, NY 12208 .u' Death Certificate Filed AlbanyDistrict Number Register Number $ : City, Town or Village 0198 065 ['Burial Date Cemetery or Crematory f ) ❑Entombment k Address ['Cremation f Date Place Removed ❑Removal and/or Held and/or Address mk Hold Date Point of ❑Transportation Shipment by Common Destination r Carrier ❑Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address , Permit Issued to Registration Number Name of Funeral Home j3v,,,,Ft cu,-tgicil. fic1. 002 _ Address Z LI (1,,c L -cat- < t�2cfM I I7V ii Name of Funeral Firm Making Disposition orlto Whom Remains are Shipped, If Other than Above Address ,F, Permission is hereby granted to dispose of the human rem ins esc ire ve as Indic tad. Date Issued November 06,2022 Registrar of Vital Statistics ames H. Arrington (signature) '`, District Number 0198 Place DVAMC, 113 Holland Avenue, Albany, New York 12208 certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Illloltt Place of Disposition `L Aat,._. (address) 9 (section) 7)J(19!number) (grave number) le Name of Sexton or Person in Charge of Premises o 1 w't1 ile (plese print) ut Signature /� �l� Title Ce�r ►��� (over) DOH-1555 (02/2004) 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#