Wall, Amelia NEW YORK STATE DEPARTMENT OF HEAL tH
Vital Real Sachon Burial - Transit Permit
Name First Mltltlle uq $ea
AMELIA WALL FETAL
Da it DeaN Age It Veteran of U .,Amwtl Porrea.
. 0eR32020 FETAL Waro.0awas
- plamoNe HMpilel, Irg41u1un
ci Taenor Mllae ALBANY or Strmt ACtlwv ALBANY MEDICAL CENTER
Manner M DeaIM1 Neutral
❑ Cause ❑ Axlaem ❑ Rnmiatle ❑ segue ❑ umerem:ree ❑ Pending
MW'imll Comfier Name Circum¢targe Ime&gatinn
MEGHAN LVSIK Tme
MD
43 N
43 NEW sCOTLANO AVE
] OeatM1CMiACaIe FIIeO D'b1M NumEar R pler NwnEw
Liry,Town w ualaga ALBANY 0101 FETAL
❑wil Dam Lemelen Orcrcmn
❑ Emmental t 08115I2020 PINEV EW CREMATORIUM
® cremation Atltlresa
OUEENSBURY NY
Oats Remoses ar Rommorm
❑ ndror arWw He'd
Hgtl AtlR%
TraspxMlim Date Pam of
❑ BYComman SM1ipmenl
Lmmr Dastlr181m
❑ Downward Date Cemreary Ailtlrew
❑ Paintful Dam LemHery Address
-! Permit laflyy To Remade NYmEw
- ' Name sFunemlHwne CARLETON FUNERAL HOME 00281
68 MI
N STREET HUDSON FALLS, NV
Na MA
Name of Funeral Firm Making Dson wto NTom
Remains are$kgpeJ, It Other Pan an ACove
AtltlR88
Wami¢¢Ien laMre2ygranYEbtllapeee MPe M1uman remain¢EeactlE Il aboaeas ' tlicatM.
Date OB/14I2020
laeuetl Registrar at Vital SPtiatica (tip
Signature
Distinct Number 101 Place CiC of Alban NY
1 nomal Mat the recall 0 Pe tlxeaem geMifieE allure were Moraetl of in examines MP this permA m.
Dam of Diapoaigen rin lro Plareml>,aroaimn Rig
haul
peaionj cal A AIL le(grovenumhwl
Name of Setlm mn or Peln Charge INPramiaea J 5-a..
peas j
sig�wlare nre �lasrl"olL
DaH-1sss lDv2ooq
wm;o realm Lew see. 4145(w) 012717
Receipt
x�rem«lo« of ,,.1; i � 11 I w W, aeu ii t� rtis 120 � a
evamuwy rsepre.munq we p�o...tmor a �t
Mod Rmw«IDmu�aa Peg.mli�mx«