O'Connell, Joan NEW YORK STATE DEPARTMENT OF HEALTH f - TV
Vital Records Section Burial - Trr Transit Permit
Name First Middle Last Sex
Joan E. O'Connell Female
Date of Death Age If Veteran of U.S. Armed Forces,
04/19/2016 74 War or Dates No
I - Place of Death Hospital, Institution
W' City ,Town or Village City of Albany or Street Address Albany Medical Center
O Manner of Death Natural ❑ Undetermined ❑ Pending
® ❑ Accident ❑ Homicide ❑ Suicide
LU Cause Circumstances Investigation
o Medical Certifier Name Title
C i Adam Austin MD
Address
43 new Scotland Ave. Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 855
Date Cemetery or Crematory
❑ Burial 04/25/2016 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
9— ❑ and/or Address
H Hold
U)
Date Point of
a Transportation Shipment
Cl)_ ❑ By Common Destination
O' Carrier
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
Address
24 Church St. Lake Luzerne, NY 12846
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
as Permission is hereby granted to dispose of the human remains descri d ove as,ipdicatefi. /
Date 04/20/2016 / ff �1�^� ��y� A��
Issued Registrar of Vital Statistics (iL�
(signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance withthis permit tton:
Z Date of Disposition mot. Place of Disposition K U..✓ (.+M4GN
W (address)
w
Cl)
c (section) (lot number) (grave number)
0
0
W Name of Sexton or Person in Charge of Premises 774iscris,..Aity(please print)
Signature a ,. /10 Title (4644
(over)
DOH-1555 (02/2004)