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Clilft, Ava 4 2.11NEW YORK STATE DEPARTMENT OF HEALTH 1r II Vital Records Section Burial - Transit Permit itil Name First Middle Last Sex • Ava Lynn Clift Female it Date of Death Age If Veteran of U.S. Armed Forces, 04/09/2018 Unknown War or Dates Place of Death Hospital, Institution or City, Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death© Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Joaquim Pinheiro MD Address UE 43 New Scotland Ave,Albany, New York 12208 • Death Certificate Filed District Number Register Number • City, Town or Village Albany 0101 0806 ❑Burial Date Cemetery or Crematory 04/11/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of " ❑Transportation Shipment by Common Destination tiii Carrier ❑Disinterment Date Cemetery Address til ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 tti Address 26 24 Church Street PO Box 500,Lake Luzerne, New York 12846 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. iii Date Issued 04/11/2018 Registrar of Vital Statistics Daniel-le S Gillespie(Electronically 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 1 ((Z ilk Place of Disposition ea 04-tic,..-, (address) (section) 14 4 (lot number) (grave number) Name of Sexton or Person in Charge of Pre ises �t �t.,^cttrt -„ ( ease print) Lit Signature or Title RiAAT it (over) DOH-1555 (02/2004)