Luse, Shirley Jul 23 2016 10:21AM HP FaxHans Funeral Home 5184V96513'1 page 1
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NEW YORK STATE DEPARTMENT OF HEALTH •
Vital Records Section • Burial - Transit ermit
zwli Name First Middle Last ..' Sex .
: t Shirley
J. Luse Female
mA Age if Veteran of U.S.Armed Forcers, . • •
`` Date of Death so War or Dates to
t", 07/20/16
' Place of Death Hospital, Institution or
City,Town or Village City of Albany Street Address Albany Medical Center Hospital
Manner of Death®Natural Cause Accident Homicide Suicide undetermined [�Pending
Circumstances investigation
Medical Certifier Name Title
Ingrid Bedinotti M.D..
Address
43 Neer Scat1and Ave... Albany, NY 12208 •
rt : Death CertiNate Filed • . District Number .,., Register Number :
:. City,Town►orYf1ac City of Albany .. 101
• Date—
• • .Cemetery or Crematory ..
srx,. ,-:: lal 07/22/2016 Pine, Vievr Crematory
• 1❑Entombmet Address
v ®Cremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or •:-Address
Hold
Date Point of'
Shipment '1'
;- OTransportation • `'
A b Common • Destination 'u ,;'1 ;V,.
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Fitemut lssuetl to •
Alexander .Baker: Firmeral..Hams! 1 ' 0039 • 1- it ,�• <
-hlnme of�urtiaral Wome i �• _,.
Address •
fit. 3809 Main St., Warrensburg, NY 12885
r.` Name of Funeral Finn Making Disposition or to Whom •
Remains.areShipped, If Other than Above
r
_. Address 3
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<' Albany. NY• -: .
M' • ,..District Number zo- •
Place Albany Police Dept.,
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