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Owens, Michael Paul ,. ( -t..- ,f,... tt 2ZZ NEW YORKSTATE DEPARTMENT OF HEALTH „�_� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michael Paul Owens Male Date of Death Age If Veteran of U.S.Armed Forces, 02/25/2024 50 Years War or Dates y., F Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital ILI p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation ui Medical Certifier Name Title 0 Simrin Kooner Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 0494 Burial Date Cemetery,Crematory or Facility Name 02/29/2024 Pine View Crematorium Entombment — Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 1 0 Q. Date Point of V)ETransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom t— Remains are Shipped,If Other than Above MOB a Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/28/2024 Registrar of Vital Statistics Kerry Bart/lo(omew(ECectronica1Ty 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: I— W Date of Disposition 3)i IN Place of Disposition 154 1.404;1evt,Z� 2 (address) W NCC (section) (lot number) (grave number) gName of Sexton or Person in Charge of ' es — !"r"4l �.,,+ft Z �,,,, (please print)al /n, Signature Title DOH-1555(07/18)p 1 of 2 I 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#