Aldrich, James Charles .-- ICF)
NEW YORK STATE DEPARTMENTOF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
JAMES CHARLES ALDRICH MALE
Date of Death Age If Veteran of U.S.Armed Forces,
01/23/24 77 War or Dates 11/14/66-11/13/72
F Place of Death Hospital,Institution or
Z City.Town or Village ALBANY Street Address 113 HOLLAND AVE.,ALBANY,NY 12208
pManner of Death ❑X Natural Cause ❑Accident El Homicide El Suicide FlUndetermined El Pending
V I—ICircumstances Investigation
111 C Medical Certifier Name Title
Foozhan Farahmand MD
Address
113 HOLLAND AVE.,ALBANY NY 12208
Death Certificate Filed ALBANY District Number Register Number
Town or Village 0198 006
Burial Date C,getery,Crematory or Faaccility�Name
1.0 ltaGtat L ► YlC Vi�4.ty lam'a"Yl(1`+-Gnj
Entombment Addre s
Cremation
Donation truce b r L
goRemoval Date Plate Removed '
pand/or and/or Held
H
N Hold Address
0
tZ Date Point of
CO[]Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑DisintermentLi
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home-ex `1/4 ,r_ zee, ;A „yl!f ( V1C.. 0�-)(
Address 1 li..&��
al-) �.ka r(k1 ,fit. L . L tk2.e'Yy/ tiAI I 1 l q
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped.If Other than Above
a Address
It
W
O. Permission is hereby granted to dispose of the human re descri above as indicated.
Date Issued 01/23/2024 Registrar of Vital Statistics ,T . Arrington
(signature)
District Number 0198 Place VAMC ALBANY 113 HOLLAND AVE.,ALBANY,NY 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition f o?7—.4OR y Place of Disposition f' V e,„) r_reyr jam {-
(address/
W
U)
Er (section)---- � (lot nrynber/, (grave number)
GName of Sexton or Person in Charge of emis f}T s0�-L 14//Oct
Z (please print)
W Signatures Title [ �r�t
DOH-1555(o7/i8)p 1 of 2 `►
7
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#