Siratanapat, Sakchai . 1/161
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sakchai Siratanapat Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/28/2023 54 Years War or Dates
F— Place of Death Hospital,Institution or
tIZJ City,Town or Village Albany Street Address Albany Medical Center Hospital
CI Manner of Death n Natural Cause Accident n Homicide Suicide Undetermined nPending
1 , Circumstances I 'Investigation
W Medical Certifier Name Title
0 Ibrahim Khatim
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 2270
Burial Date Cemetery,Crematory or Facility Name
09/29/2023 Pine View Crematory
Entombment Address
nCremation Queensbury Town,New York
Donation
ZO n Removal Date Place Removed
and/or and/or Held
Hold Address
0
Date Point of
Cl)ElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
0
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/29/2023 Registrar of Vital Statistics Ferry Bartholomew(Ekctronical61Signed)
(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:
IH
Z Date of Disposition iO/z 173 Place of Disposition rrveviIFt.J 'vt 1 'turfj
2 (address)
W
CC
CC (section) /I (lot number) (grave number)
0 Nameof Sexton or Person in Charge of Pre
Z 4ase pant) /(® 4A,0(Signature Title
l
Public Health Law Sec. 4145(2b)
Receipt
Human remains of Y " delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#