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Allen, Sally NEW YORK STATE DEPARTMENT OF HEALTH r `S t Vital Records Section a Burial - Transit Permit Name First Middle Last Sex • Sally A.Allen Female • Date of Death Age If Veteran of U.S. Armed Forces, • 07/08/2017 58 Years War or Dates F Place of Death _.Hospital, Institution or City, Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death© Natural Cause ❑Accident Homicide ❑Suicide ❑ Undetermined El❑Pending Circumstances Investigation f Medical Certifier Name Title Mary Maskell-Amirault NP Address • 43 New Scotland Ave,Albany, New York 12208 Death Certificate Filed District Number Register Number • City, Town or Village Albany 0101 1493 geL ElBurial Date Cemetery or Crematory 07/10/2017 Pine View Crematory • ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held • and/or Address Hold Date Point of • Transportation Shipment i by Common Destination • Carrier Disinterment Date Cemetery Address il_ El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Stpo Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address m• Permission is hereby granted to dispose of the human remains described above as indicated. Pk Date Issued 07/10/2017 Registrar of Vital Statistics Danwfi sciflespie ECectronicaaySigned" (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 7 ill I n Place of Disposition f niVN-+ Ami fior (address) 7 (section) /(lot number) (grave number) Name of Sexton or Person in Charge of Pre ises abr,rlpir �t.Aiir /, (plh�ase print) Signature �r tar Title Mi...MINFA (over) DOH-1555 (02/2004)