Morgan, Jacqueline 93_3
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
JACQUELINE MARIE MORGAN FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
12/25/2016 73 War or Dates
I— Place of Death Hospital, Institution
Z City, Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Q Manner of Death ® Natural El Accident ❑ Homicide I:] Suicide ElUndetermined ❑ Pending
LU Cause Circumstances Investigation
WMedical Certifier Name Title
p BENJAMIN METCALFE MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 2719
Date Cemetery or Crematory
❑Burial 12/28/2016 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
H Hold
CO
0 Date Point of
a Transportation Shipment
V) ❑ By Common Destination
El- Carrier
El Disinterment
Cemetery Address
Disinterment
ElDate Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home BAKER FH 01130
Address
11 LAFAYETTE ST., QUEENSBURY NY 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
11]
a- Permission is hereby granted to dispose of the human remains descr' abo sin te• R
Date 12/27/2016 (10 )11 _
Registrar of Vital Statistics ,i j �' 1`-'v ,
Issued (si " tune)
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//2/1& Place of Disposition T /�100r� Z-leyneti71v l
W (address)
to
co
re (section) (lot number) (grave number)
0 ``
Name of Sexton or P on in Charge of Premises
J 14- i.-O-.VI -WC,C-A.t
UJ (please print)
Signature Title 6fej 4,
(over)
DOH-1555 (02/2004)