Wagner, Sarah N.
# (er
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sarah Rose Pat Wagner Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/10/2018 40 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death E Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Morgan Spurgas MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 2244
. DBurial Date Cemetery or Crematory
10/16/2018 Pine View Crematory
['Entombment Address
a®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/15/2018 Registrar of Vital Statistics Danielle S Gaspe(E(ectronica(ty Signed)
(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:
Date of Disposition /0 JIb lig Place of Disposition ',Al., l°,
(address)
r.
g (section) (lot numbbxr) (grave number)
Name of Sexton or Person in Charge of Premises t x ' (.� ) cM4
/A/ (please print)I
Signature (i'� ,.//r Title irrivill TO&
(over)
DOH-1555 (02/2004)