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Thompson Jr., Harold D
# LI(03 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Harold D Thompson Jr Male Date of Death Age If Veteran of US.Armed Forces, 05/29/2023 58 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital WW Manner of Death M Natural Cause Accident Homicide ESuicide Undetermined ri Pending C) Circumstances Investigation Q Medical Certifier Name Title Omar Daghstani Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 1283 EIBurial Date Cemetery,Crematory or Facility Name 06/02/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held Hold Address M❑Transportation Date Point of $ by Common Shipment Carrier Destination ElDisinterment 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 „X Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/01/2023 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: IN- Z Date of Disposition ( I Z 123 Place of Disposition V_ILI 2 (address) W Cr N (section) (lot number) cm (grave number) 8 Name of Sexton or Person in Cha e of P ises r Z /p se print) W Signature Title � /m�l� DOH-1555(o7h8)p i of 2 Public Health Law Sec. 4145(2b) '' ' 0 Receipt Human remains of delivered on , 20 _ Pine View Cemeta4y Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#