Fomo, Carol Egi
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carol Forno Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/15/2017 73 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death Natural Cause 0 Accident Homicide D Suicide �Undetermined Ei Pending
Circumstances Investigation
Medical Certifier Name Title
Luke Duncan MD
Address
47 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 1547
❑Burial Date Cemetery or Crematory
07/17/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or
Address
:fw• Hold
Date Point of
• Transportation Shipment
by Common Destination
el Carrier _
0 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
• Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
*per
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/17/2017 Registrar of Vital Statistics DanielleSGaspe EfectronicaffySigned
(signature)
District Number o101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7,y,7 Place of Disposition pdi.t. (address)
a> (section) (lot numb r) (grave number)
Name of Sexton or i Ch ge of Premises Jam-/ r��t 0'1
(please print)
Signature Title
(over)
DOH-1555 (02/2004)