Varmette, Georgianna p3 J '-aNEW YORK STATE DEPARTMENT OF HEALTH , -,,,.4 Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Georgianna Varmette Female
t~a Date of Death Age If Veteran of U.S.Armed Forces,
05/03/2017 80 War or Dates
4.4 Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address albany medical center
Manner of Death Natural ❑ Undetermined ❑ Pending
® ❑ Accident ❑ Homicide ❑ Suicide
W Cause Circumstances Investigation
'fir Medical Certifier Name Title
Jared Campbell MD
Address
43 New Scotland Ave.
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 101 1015
Date Cemetery or Crematory
❑ Burial 05/05/2017 Pine View Crematorium
❑ Entombment Address
®Cremation 407 Bay Rd. Queensbury, New York 12804
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
F—' Hold
(1)
er Date Point of
; Transportation p
N' ❑ By Common Shipment
a Carrier Destination
❑ Disinterment Date Cemetery Address
❑ Date Cemetery Address
Renterment
x_ Permit Issued To Registration Number
,, Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
, 407 Bay Road Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
""` Remains are Shipped, If Other than Above
1, Address
Permission is hereby granted to dispose of the human remains de ed abgve as indi d -
Date 05/05/2017 Registrar of Vital Statistics
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance� with this permit on:
Date of Disposition S f 5 117 Place of Disposition 0t( +h1 in
Lu (address)
a
w
Cl)
r' (section) ,, lot number) (grave number)
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WName of Sexton or Person in Charge of Premises trx-trlr_ ,Sg_,v1
(please print)
If/Signature Title 1 . N
(over)
DOH-1555 (02/2004)