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Pruyn, Victoria NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last TF Victoria Pruyn ale Date of Death Age If Veteran of U.S.Armed Forces, 12/03/2019 60 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title Tessa Harland MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2627 © Burial Date Cemetery,Crematory or Facility Name 12/09/2019 Pine View Cemetery Entombment Address ❑Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held H CO) Hold Address O d Date Point of N 0 Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home New Comer Cremations&Funerals(01253) 01253 Address 343 New Karner Rd,Albany,New York 12205 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2019 Registrar of Vital Statistics Da-,,&SC�illerpie(ElectronicalfySzgned� (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: H Z Date of Disposition �, - Place of Disposition R 1 W (address) LU e, a6- 3 CO) (s i J (lotnumber) (grave number) x (.'� Name of Sexton erson in Charge of Premises �� ��' L "6,b, Z (Please grin W Signature t DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010357 Receipt i Human remains of delivered on , 20 -- ne View Ce ete` Representing the funeral hoT!*med on burial permit Official Funeral Directors Reg.or License NAME Age: Victoria Pruyn 60 Lot Owner: Howard H. Pruyn Lot# Grave# 3, 26, 33 13 Case: Concrete Died: 1 2/3/2 01 9 Interred: 12/9/2019 Funeral Home: New Comer Cremations Cemetery: Pine View Cemetery