Steinhaver, Karen-Lynn NEW YORK ST4TE DE. ARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Karen-Lynn Steinhaver Female
Date of Death Age If Veteran of U.S.Armed Forces,
June 24, 2013 30 War or Dates No
j- Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address Albany Medical Center
a Manner of Death Natural Undetermined Pending
® ❑ Accident ❑ Homicide ❑ Suicide ❑ ❑
W Cause Circumstances Investigation
W Medical Certifier Name Title
G' Batyrjan Bulibek MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1230
Date Cemetery or Crematory
® Burial June 28, 2013 Pine View Cemetery
El Entombment Address
El Cremation Queensbury, NY
Date I_Place Removed-
Z Removal and/or Held
O' ❑ and/or Address
H' Hold
N
Q' Date Point of
d Transportation Shipment
N ❑ By Common
0 Carrier Destination
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home Maynard D. Baker 01130
Address
11 Lafayette Street, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2' Address
CC
In
0- Permission is hereby granted to dispose of the human remains described aboZt ' Q
as indicated
Date June 26, 2013 Registrar of Vital Statistics 2 `
Issued (signature) / f
District Number 101 Place City of Albany, NY 7-1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 6/28/1 3 Place of Disposition Pine View Cemetery
w (address)
co Seneca 23 B 3
tY (section) (lot number) (grave number)
0
o' Connie L. Goedert
uName of on or Person in Charge of Premises
(please print)
5,0 Signa ejilu,!? tG Title Superintendent
(over)
DOH-1555 (02/2004)