Martin, Virginia 0
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Virginia Martin I Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/13/2020 66 Years War or Dates
Ii.— Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
LU
'p Mannerof Death ❑X Natural Cause Accident ❑Homicide Suicide ❑Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
0 Tara Fitzgerald NP
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0088
❑Burial Date Cemetery,Crematory or Facility Name
01/14/2020 Pine View Crematory
Entombment Address
RI Cremation Queensbury Town,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
H usHold Address
O
a Date Point of
fA ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
[Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
E... Remains are Shipped,If Other than Above
Address
lx
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/14/2020 Registrarof Vital Statistics DDan,eIkSCj,Yerpie(EYectroaicad Sozed)
(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:
t-
Z Date of Disposition (, ZO Place of Disposition t �,,, a-A--
LU (address)
2
W
CO)
(section) `�/�lot number/ (grave number)
a Name of Sexton or Person in Charge of Premises (P
(pl se print)
W Signature Title r
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 01 132 4 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#