Paul, Lila ,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Lila Paul Female
Date of Death Age If Veteran of U.S.Armed Forces,
July 16, 2006 80 War or Dates No _
Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address Community Hospice, 315 S. Manning Blvd.
,41.10 Manner of Death Natural
W" ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
C Richard Balsam MD
Address
1365 Washington Ave., Albany, NY 12206
Death Certificate Filed District Number Register Number
3 City,Town or Village City of Albany 101 1256
® Burial Date Cemetery or Crematory
July 19, 2006 Shaaray Tefila Cemetery
Address
❑ Cremation Glens Falls, NY
Date Place Removed
Z Removal and/or Held
0 El and/or Address
Hold
CO
Date Point of
d Transportation Shipment
CO ❑ By Common Destination
p Carrier
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued To
Registration Number
tx
Name of Funeral Home Levine Memorial Chapel, Inc. 01093
Address
649 Washington Ave., Albany, NY 12206
MName of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ZPermission is hereby granted to dispose of the human remains described above a indicated.
tv
Date July 18, 2006
Issued -Reg_istrar of Vital Statistic ` -- ��f
(signature) .
If
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t- Date of Disposition Place of Disposition
w (address)
W
4ca-
(section) (lot number) (grave number)
L
Z Name of Sexton or Person in Charge of Premises
LAI
(please print)
Signature Title
(over)
DOH-1555(9/98)