Borjese, John J It 0
NEW YORK STATE DEPARTMENT OF HEALTH LF st- 12 2_
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John J Borghese Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/3/2024 69 War or Dates 10/09/1975-10/05/1979
f~ Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address DVAMC,113 Holland Ave.,Albany,NY 12208
O Manner of Death Z Natural Cause Accident 0 Homicide DSuicide 111Undetermined Pending
W U Circumstances Investigation
W Medical Certifier Name Title
G Naeem Ahmed MD
Address
113 Holland Ave.Albany,NY
Death Certificate Filed Albany District Number Register Number
City,Town or Village 198 008
Burial Date Cemetery,Crematory or Facility Name
aa1os1�v-I P r\e u 1 Q L_3 c_r recNouka r\--Q
Entombment
Address (� �`
Cremation CbL Y),.V-.e X l2 J - 6
0 SLR..►' -S b(�-�l Iv`-t I 2164
Donation
0❑Removal Date Place Removed
and/or and/or Held
t~
N Hold Address
0
O. Date Point of
N 0Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
PermiName Issued ro
a R.€ a QY\ OQfl IA l ` S If C_ y'>�� Registration0 I.L Abel 7
Name of Funeral Home `-- 6 'l h v �1,"b..�
Address
5 3 OcI,.l1-\- -► - 12--0- - Dc,v e_e.rv_sb u-r`.-P , k)q 1. 2-2 64
Name of Funeral Firm Making Disposition or to Whom
p. Remains are Shipped,If Other than Above
a Address
Q
W
O. Permission is hereby granted to dispose of the human r i escribed ve as indicated.
Date Issued 2/3/24 Registrar of Vital Statistics James H.Arrington
(signature)
District Number 198 Place DVAMC, 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:
Date of Disposition Z l l t 24 Place of Disposition -Fait vw,..) G,wl Al AN,LN--
LLI
a (address)
W
1 (section) A (lot number) (grave number)
2 Name of Sexton or Person in Charge of Premin, 41
Z (plea e print)
W Signature7.',,,jTitle PfAnti IV'
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#