Smith, Joan t i
NEW YORK STATE DEPARTMENT OF HEALTH '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joan B. Smith Female
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 08 / 2017 83 War or Datel_ N/A
Place of Death Ho ital, Institutibn or
ZCity, Town or Village Albany Street Address Albany Medical Center
Manner of Death®Natural Cause E Accident ❑Homicide E Suicide ri Undetermined 0 Pending
Circumstances Investigation
tti Medical Certifier Name Titl
44 James R. Wyant
Address
47 Ncotland,Rye. , Albany, NY 12208
Death Certificate Filed District Number Register Abelr
City, Town or Village Albany 1 () t Ilt
»' 0Burial Date Cemet y or Crematory
-1 / b/ 1.1 Pine View Crematory
Entombment /
Address
iiiiii ECremation Queensbury, NY
in Date Place Removed
❑Removal , and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
iMi Carrier
Disinterment Date Cemetery Address
i*:€Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
00 Address
i
"` Permission is hereby granted to dispose of the human r ains described above as indicated.
: Date Issued —1.110k\\ Registrar of Vital Statistics '�> i. °L DV k 0 Q
(signature) ` I
Mii District Number tp t Place lbany , New York
tiiii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
UIDate of Disposition 111 I f Place of Disposition 'fin,v.r Ane{or,f.,,,
(address)
tii
(11
IGU (section) lot number) (grave number)
II
0 Name of Sexton or Person in Charge of Premises �{r�tkQ�Y` S[��/i+�
,i (plea#fe print)
1 Signature G� Title iletrimpt
(over)
DOH-1555 (02/2004)