Romer, Pamela NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
• Pamela Sue Homer Female
Date of Death Age If Veteran of U.S. Armed Forces,
• 0711912018 64 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
et Manner of Death j Natural Cause ❑Accident 0 Homicide El Suicide ❑Undetermined ri❑Pending
W Circumstances Investigation
iti Medical Certifier Name Title
Kellsey Peterson MD
—
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 1585
'' rgiBurial Date Cemetery or Crematory
07125/2018 Pine View Cemetery
0 Entombment Address
QCremation Queensbury Town, New York
Date Place Removed
0 Removal and/or Held
• and/or Address
Hold
O ~— Date Point of
11.CO [�Transportation Shipment
a by Common Destination
:` Carrier
al• LiDisinterment Date Cemetery Address
0
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
:. . Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
4 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
tOleiii
2 Address
IX,
WI
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/20/2018 Registrar of Vital Statistics Danie(e S gi(aispie jE(ectronicat ySieve
(signature)
District Number 0101 Place Albany, New York
Fri I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition 7/25/201 Place of Disposition Pine View Cemetery Queensbury
04
(address)
Erie 15-C 2
(section) (lot number) (grave number)
et Name of Se ton or Person in Charge of Premises Connie Goedert
Z (please print)
Signature .` e.,...,„( Title Cemetery Superintendent
(over)
DOH-1555(02/2004)