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Russo, Dennis Peter
It 1 1 9 • NEW YORKSTATE DEPARTMENT OF HEALTH 1140F Bureau of Vital Records Burial - Transit Permit 4 Name First Middle .. Last Sex Dennis Peter Russo Male Date of Death Age If Veteran of U.S.Armed Forces, 02/20/2024 63 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p• Manner of Death El NaturalCause nAccident ❑Homicide Suicide Undetermined Pending V I—ICircumstances Investigation ILI Medical Certifier Name Title CI Zachary Kimball MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 0449 }Burial Date Cemetery,Crematory or Facility Name 02/23/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation o❑Removal Date Place Removed and/or and/or Held F- Hold Address CO 0 O. Date Point of U) Transportation G by Common Shipment Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom (— Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2024 Registrar of Vital Statistics Kerry Bartholomew(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: Date of Disposition a—; ?(724/ Place of Disposition / iJe y'e„0 Cr' j h gIJJ Z' (address) tU Q (section) ` (lot numbe/ (grave number) SName of Sexton or Person in Charge of Premises !/I-4Ket9.t%/� ld0/.Z Z ---� (please print) LU Signature c .0rl�� :14"' Title c,(�r� r DOH-1555(o7/18)p 1 of 2 6/ I Public Health Law Sec. 4145(2b) Receipt 1 1 7 Human remains of delivered on , 20 1 1 1 Pine View Cemetery Representing the funeral home named on burial permit 1 Official Funeral Directors Reg.or License#