Koble, Vera NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
--T
Name First Middle Last Sex
VERA KOBLE FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
4/12/2017 94 War or Dates
Place of Death Hospital, Institution
Z City ,Town or Village City of Albany r Street Address ST. PETER'S HOSPITAL
Manner of Death Natural
Cl Undetermined Pending
WW ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
W Medical Certifier Name Title
FREDERICK GRIFFITHS MD
Address
315 S MANNING BLVD ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village Cityof Alban 101 866
Date Cemetery or Crematory
® Burial El Entombment 4/14/2017 JSHAARAY TEFILA CEMETERY El Cremation Cremation GLENS FALLS, NY
Date Place Removed
Removal and/or Held
0 ❑ and/or Address
Hold
d Transportation Date Point of
Shipment
_ ❑ By Common
Carrier Destination
❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued To Registration Number
Name of Funeral Home LEVINE MEMORIAL CHAPEL INC 01035
Address
649 WASHINGTON AVE., ALBANY NY 12206
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W
CL Permission is hereby granted to dispose of the human remains descr be abo as,ind to
Date 4/14/2017
Issued Registrar of Vital Statistics
(sign ture)
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 one:� �'
Z Date of Disposition �/lr� / Place of Disposition / �r' C 141,L�
W (address)
z
W
N
(section) (lot number) (grave number)
O /
Z' Name of Sexton or Person in Charge of Premises //tee `cyj�e Z
w (please print) v
t
Signature Title
(over)
DOH-1555 (02/2004)