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Lang, Chad E ho I F ) NEW YORKSTATE DEPARTMENT OF HEALTH , Burial -Transit Permit Bureau of Vital Records Name First Middle Last Sex Chad E Lang Male Date of Death Age If Veteran of U.S.Armed Fortes, 08/29/2023 49 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany MedicaLCenter Hospital w Manner of Death Undetermined Pending 0 Natural Cause ®Accident Homicide Suicide W V Circumstances Investigation W Medical Certifier Name Title 0 Paul Marra Coroner Address 112 State Street,Albany,New York 12207 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 2029 Burial Date Cemetery,Crematory or Facility Name .' 08/31/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York 0 Donation 60 Removal Date Place Removed and/or and/or Held t= Hold Address N 0 Date Point of Cl)❑Transportation Shipment a by Common 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 i.. Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/31/2023 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: E- ` / Z Date of Disposition �/"ZD Zj Place of Disposition �,.J e j�.e..J L n r1+1 Pa•fe-4" 2 (address) W cc (section) (lot nul r) (grave number) 8 Name of Sexton or Person in Charge of P ises t )ia Ym0.4 D Wooci z (please print) W Signature / Title Offe Gie DOH-1555(07/18)p 1 of 2 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#