Jones, Gabriella NEW YORK STATE DEPARTMENT OF HEALTH # 2��
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gabriella Rose Jones Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/30/2016 24 days War or Dates
ilk Place of Death Hospital, Institution
City ,Town or Village City of Albany or Street Address Albany Medical Center Hospital
0 Manner of Death Natural Undetermined Pending
Li Li Accident ® Homicide ❑ Suicide ❑ ❑
Cause Circumstances Investigation
Medical Certifier Name Title
ice'; Michael Sikirica MD
I, Address
112 State Street Albany, NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 702
Date Cemetery or Crematory
❑ Burial 04/01/2016 Pine View Cematorium
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
52 ❑ and/or Address
i*!- Hold
CO•
0 Date Point of
a Transportation Shipment
❑ By Common Destination
p Carrier
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
❑
Reinterment
. Permit Issued To Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc 00141
Address
9 Pine Street Chestertown, NY 12817
Name of Funeral Firm Making Disposition or to Whom
�` Remains are Shipped, If Other than Above
Address
,,
Permission is hereby granted to dispose of the human remains descri ab ve as in i e
Date 04/01/2016 Re istrar of Vital Statistics ""� /l/ d.���'�-�C
Issued g ( ignature)
District Number 101 Place City of Albany, NY
I certify that the remains
Jof the decedent identified above were disposed of in accordance with this permit on:
h, Date of Disposition -j/i lid Place of Disposition v`^1 ` i_
W' (address)
W
U!
fX (section) if(lot number) (grave number)
0
ZName of Sexton or Person in Charge of Premises i)t, k. bI^st
W (please print)
Signature
Title alkilillt
(over)
DOH-1555 (02/2004)