Davidson, Jeannett NEW YORK STATE DEPARTMENT OF HEALTH , it t
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeannette Edith Davidson Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 17,2013 55 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address St. Peters Hospital
a Manner of Death ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
lit Circumstances Investigation
la Medical Certifier Name Title
G'
Address
Death Certificate Filed District Number Register Number
1 City,Town or Village City of Albany,NY
❑Burial Date Cemetery or Crematory
July 23,2013 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road, Queeensbury, NY 12804
Date Place Removed
ZZ El❑Removal and/or Held
and/or Address
E Hold
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0 Date Point of
gin Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
a Address
re
n' Permission is hereby granted to dispose of the human re ains described above as indicated.
Date Issued 07-2 Ja/1 Registrar of Vital Statistic �-- - �� Vert i✓
(signature)
District Number NY Place City of Albany,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
MI Date of Disposition 7- 23.11 Place of Disposition gruiVto. ��rirctd!.�►-
(address)
W
U)
CL
(section) pot number (grave number)
QName of Sexton or Person i Charge of Pre ises t.� Bn4
Z (Wiese print)
W Title CIZ 'M14i�C.
Signature �_
(over)
DOH-1555(02/2004)