Messier, Winifred NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Winifred H. Messier FEMALE
- Date of Death Age If Veteran of U.S.Armed Forces,
03/29/2014 86 War or Dates No
f;- Place of Death Hospital, Institution
W• City ,Town or Village City of Albany or Street Address Albany Medical Center
W' Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Cause Circumstances Investigation
W Medical Certifier Name Title
p, Dominick Guerrero MD
Address
43 NEW SCOTLAND AVENUE. ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 635
Date Cemetery or Crematory
® Burial April 2, 2014 Pine View Cemetery
❑ Entombment Address
❑ Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
I Hold
rii
Date Point of
a Transportation Shipment
• ❑ By Common Destination
Carrier
El Disinterment
Cemetery Address
Disinterment
Date Cemetery Address
❑
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other than Above
Address
LU
O- Permission is hereby granted to dispose of the human remains described above s indicated.
Date April 1, 2014 t 3741
Registrar of Vital Statistics e,af i it x
Issued (signatur
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:
~ Date of Disposition 4/2/2014 Place of Disposition Pine View Cemetery
w (address)
2
m Oneida 183 2
ix
(section) (lot number) (grave number)
0
o"
W Name of Sexton or Person in Charge of Premises Connie L. Goedert
(please print)
t Superintendent
Signatur 3n � A . �rL i 0 Title
j (over)
DOH-1555 (02/2004)