Grabbe, Coraline 'T ) 3I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
ammisw
Ili' Name First Middle Last Sex
F
Coraline Eileen Rose Grabbe
., Date of Death If Veteran of U.S.Armed Forces,
- 1 1 /4/2 01 1 T4+- War or Dates
) Place of Death Hospital, Institution Alban Medical Center
Z City ,Town or Villa e CITY OF ALBANY or Street Address Y
1 Manner of Death Natural Undetermined Pending
1LU Cause ❑ Accident El ❑ Suicide ❑ Circumstances ❑ Investigation
Medical Certifier Name Title
Q' Marilyn A. Fisher MD
i! Address
43 New Scottland Ave. Albany, NY 12208
,y Death Certificate Filed District Number Register Number
City, Town or Village CITY OF ALBANY 101
Date Cemetery or Crematory
❑ Burial 1 1 /8/2011 Pine View Crematory
Address
2( Cremation Queensbury, New York
Date Place Removed
Z Removal and/or Held
0 ❑ and/or P Hold Address
C
O Date Point of
d Transportation Shipment
❑ By Common 0 Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
:, Permit Issued To Registration Number
Name of Funeral Home Singleton—Healy Funeral Home 01 596
k Address
,t `. 407 Bay Road Queensbury, New York 12804
4-1, Name of Funeral Firm Making Disposition or to Whom
1h- Remains are Shipped, If Other than Above
Address
i
d Permission is hereby granted to dispose of the human remains des be bo e i ' at d.
cn
Tel
Date 1 1 /6/2 01 1 Registrar of Vital Statistics i/
Issued signature)
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 permit on:
Z Date of Disposition It h"1J i Il Place of Disposition P f_LU 1 to l tweloi.i..
w (address)
M
W
U)
0
0 (section) (lot numb (grave number)
0
WName of Sexton or Person in Charge of Premises (1(+1k 1 r t h
(please print)
Signature /1/111' Title ( mAi
(over)
DOH-1555 (9/98)