White, AnnaN EW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
Burial - Transit Permit
Name First Middle Last
Sex
Anna G. White
Female
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/25/2019
92 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 El Natural Cause Accident Homicide Suicide Undetermined Pending
W
Circumstances Investigation
U
W
Medical Certifier Name Title
Robert Wilcott MD
Address
43 New Scotland Ave, Albany, New York 12208
Death Certificate Filed
District Number
Register Number
City, Town or Village Albany
0101
2074
❑ Burial
Date Cemetery, Crematory or Facility Name
Entombment
09/30/2019 Pine View Crematory
Address
KCremation
Queensbury, New York
Donation
Z
Removal
Date
Place Removed
and/or Held
~
and/or
Hold Address
N
0
n.
Date Point of
Vl
Q
❑ Transportation Shipment
by
Common
Carrier
Destination
Disinterment
Date
Cemetery Address
Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Regan & Denny Funeral Service
01444
Address
94 Saratoga Ave, S Glens Falls, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Otherthan Above
Address
W
a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2019 Registrar of Vital Statistics Da--&S jC,&rpw(Electro-kaLySrgned)
(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: `
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Date of Disposition 10+1 � LPlace of Disposition OF. r"�►��tA—
Uj
(address)
W
N
(section) (lot number) (grave number/
0
Ia
Name of Sexton or Person in Charge of Premises
(p ase print/
Z
/
W
Signature /� „(" Title
DOH-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b) +
012566
Receipt
Human remains of
Pine View Cemetery
Official
delivered on , 20
Representing the funeral home named on burial permit
Funeral Directors Reg. or License #