Haskin, Carole NEW YORK STATE DEPARTMENT OF HEALTH tk. Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Carole Raskin Female
Date of Death Age If Veteran of U.S.Armed Forces,
I. December 24, 2017 67 War or Dates
2 Place of Death Hospital, Institution or
W City,Town,or Village Albany Street Address Albany Medical Center
Q Manner of Death n Natural Cause n Accident n Homicide n Suicide 0 Undetermined Ell Pending
W Circumstances Investigation
U Medical Certifier Name Title
W Barbara Yang MD
Q Address
48 New Scotland Ave. Albany Ny 12208
Death Certificate Filed District Number /� f O' Regsstgr Number
City,Town or Village Albany U i L (At
n Burial Date Cemetery or Crematory
December 29, 2017 Pineview Crematorium
❑Entombment Address
0 Cremation 21 Quaker Road Queensbury, NY 12804
2 Date Place Removed
0 n Removal and/or Held
- and/or Address
1' Hold
0 Date Point of
0 n Transportation Shipment
i by Common Destination
Carrier
Date Cemetery Address
0 Li Disinterment
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
2▪ Name of Funeral Firm Making Disposition or to Whom
ix ix Remains are Shipped, If Other than Above
W Address
IL
Permission is hereby granted to dispose of the human remains escribed ove as indicated.
Date Issued t 2 h /i1 Registrar of Vital Statistics
(signature
District Number no i Place Albany,New York
1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
W Date of Disposition 12/29/2017 Place of Disposition Pineview Crematorium
W (address)
41
it
(section) (lot number) (grave number)
C Name of Sexton or Person i Charge of Premises �in,11 ,,,,.t �� Ate,.L
W (phase print)
Signature lr' — Title L re rr+-</d
(over)
DOH-1555 (02 004)