Grabbe, Victoria ►t 'J v
NEW YORK STATE DEPARTMENT OF HEALTHIIIIII Burial - Transit Permit
Vital Records Section r
tk Name First Middle Last Sex
=F:
Victoria Ann Quinn Grabbe F
41, Date of Death If Veteran of U.S.Armed Forces,
11 /3/2011 44 War or Dates
1= Place of Death Hospital, Institution
Z City ,Town or Villa e CITY OF ALBANY or Street Address Albany Medical Center
n` Manner of Death Natural Undetermined Pending
a:Lli Cause ❑ Accident ❑ Homicide ID Suicide ❑ Circumstances ❑ Investigation
. Medical Certifier Name Title
tx Marilyn A. Fisher MD
Address
s F'
43 New Scottland Ave. Albany NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village CITY OF ALBANY 101
❑ Date Cemetery or Crematory
Burial 1 1 /8/2 01 1
Pine View Crematory
Address
Cremation Queensbury, New York
Date Place Removed
Z Removal and/or Held
O: ❑ and/or Address
Hold
cn
0 Date Point of
d Transportation Shipment
C ❑ By Common
a Carrier Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Vrtil Permit Issued To Registration Number
Name of Funeral Home Singleton—Healy Funeral Home 01 596
OFF Address
407 Bay Road Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
11
Address
lit
4'' Permission is hereby granted to dispose of the human remains describ a v s Indic
,.,. Date 1 1 /6/2 01 1 Registrar of Vital Statistics
Issued ature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance w with this permit on:
Z Date of Disposition it I ill Place of Disposition Qv.,Qv.,Va u! 6rci+arav*
W (address)
M
W
Cl)
0
0 (section) (lot number) (grave number)
CI
W (please print)Name of Sexton or Perso in Charge of Premises l r,y �r p tfi
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Signature Title rae.N1 Zof—
(over)
DOH-1555 (9/98)