Schmidt, Baby t . , , 1/Z101
NEW YORK STATE DEPARTMENT OF HEALTH ea ilp Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
BABY SCHMIDT FETAL
Date of Death Age If Veteran of U.S.Armed Forces,
3/27/2017 FETAL War or Dates
I— Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Q Manner of Death Natural ❑ Undetermined ❑ Pending
W ❑ Cause ❑ Accident ❑ Homicide ❑ Suicide
Circumstances Investigation
W' Medical Ce ifi:i Name Title
C) • s,` CATHERINE BRADSHAW . MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 FETAL
Date Cemetery or Crematory
❑ Burial 4/3/2017 PINEVIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
H Hold
er, Transportation Date Point of
p
Cl) ❑ By Common Shipment
El Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home REGAN DENNY STAFFORD FH 01443
Address
53 QUAKER RD QUEENSBURY NY 12804
Name of Funeral Firm Making Disposition or to Whom
H. Remains are Shipped, If Other than Above
ate, Address
Ll!'
EL Permission is hereby granted to dispose z:h:
human remains descr b above as,ind to VI Lk�
Date 3/31/2017 V '�
Issued rar of Vital Statisticsn ture) �
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 permiton:
Z Date of Disposition Li in Place of Disposition 'FM.V i� Lwr+1 Jt --
w (address)
E
w
rt (section) (lot number) z. (grave number)
O
714 W• Name of Sexton or Person in Charge of Premises „� r— GNq L'
(please print)
Signature LIZ
i Title (f ir"r'l,
(over)
DOH-1555 (02/2004)