Bovee, Baby Girl a
NEW YORK STATE DEPARTMENT OF HEALTH P Burial - Transit ermit
Vital Records Section 4
Name First 7. (3_,illidd (7 Last $ex
te---,,eitere
,,,, Date of Death `f% �d?� Age, If Veteran of U.S.Armed Forces,
6War or Dates
Place of Death t Hospital, Institution
City,Town or Village City of Albany or Street Address
erei Manner of Death - Natural Accident ❑ Undetermined ❑ Pending
"' Cause ❑ ❑ Homicide ❑ Suicide Circumstances Investigation
Medical Certifier Name .i i Tit
EA z
/ Zge /2
m Death Certificate Filed District Number Register Number
City,Town or Village City of'Albany 101
❑ Burial Date , C etery or Cre/matory�j� y'
7
Address i 7 , t '
Cremation / /Z J L
Date Place Re+rtiov‘d
Removal and/or eld
1-7
0. ❑ and/or Address
Hold
In_ Date Point of
Lt. Transportation Shipment
S? ❑ By Common 0 Carrier Destination
Date Cemetery Address
❑ Disinterment
❑ Reinterment
Date Cemetery Address
a.iip Permit Issued To J ��� ,,',� � ��i� R s atlii Number
Name of Funeral Home ,/ a[ zz,„ -�I'fk �%7.,07f' �!G2 ;�'`�(Address
' ' '.7'' z,,,,,,,,, ,,,y7/;2 -i=----- ---:'
s Nam` of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above a 'ndicated.
Date `l-)_ O S Registrar of Vital Statistics 3
Issued / ��������
(signature)
04.
District Number 101 Place Albany City Police Department
,3
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z Date of Disposition if-- 9 ti Place of Disposition P 1�N )?� u,/ ,i- , ,4kC ir2 t),h�
(address)
iti
tli
section( )) (lot number) (grave number)
3: Name of Sexton or Person in Charge of Premises a-'0 Wes',-(' Ca.,rz�-3,(.�
(please print)
Signature epze.,t a,4.4 Title a''t-4.-tr.c4 \?
(over)
DOH-1555(9198)