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Casey, Delilah NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit • Name First Middle Last Sex Delilah Evelyn Casey Female • Date of Death Age If Veteran of U.S.Armed Forces, fletyi 09/19/2018 1 Hrs.46 Mins. War or Dates , Place of Death Hospital, Institution or City, Town or Village Albany Street Address Albany Medical Center Hospital k::` Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending : Circumstances Investigation s:;' Medical Certifier Name Title ``,'' Haritha Sishtla MD Address • 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number • City, Town or Village Albany 0101 2073 'El Burial Date Cemetery or Crematory 09/21/2018 Pineview Crematorium ❑Entombment Address ®Cremation Queensbury Town, New York FA Date Place Removed t, ❑Removal and/or Held and/or -' Address Hold fir; Date Point of I ❑Transportation Shipment by Common Destination IV Carrier ❑Disinterment Date Cemetery Address .- ❑Reinterment Date Cemetery Address TY Oa Permit Issued to Registration Number N• ame of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom xz Remains are Shipped, If Other than Above `- A• ddress e ,1 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/20/2018 Registrar of Vital Statistics cDaniel7e s ccillespie g etronically 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: D• ate of Disposition q'zylit Place of Disposition CA,- *a to",_ (address) (section) dr:fheik,(lot number) N� (grave number) x J /• Name of Sexton or Person in Charge of Premises / �� ,:, (please print) Signature ./e/ Title /IL M rilit (over) DOH-1555 (02/2004)