Prindle, Baby NEW YORK STATE DEPARTMENT OF HEALTH leBurial - Transit t@rit
Vital Records Section r , t
Name First Middle Last Sex
Baby Prindle Fetal
Date of Death Age If Veteran of U.S.Armed Forces,
March 9, 2011 Fetal War or Dates
I— Place of Death Hospital, Institution
W' City,Town or Vil ge City of Albany or Street Address Albany Medical Center
Manner of Death Natural Undetermined Pendin
W Cause
❑ Accident ❑ Homicide ❑ Suicide
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Circumstances ❑ Investigation
W' Medical Certifier Name Title
CI Camille Kanaan MD
Address
AMCH, 43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101
Date Cemetery or Crematory
❑ Burial March 14, 2011 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or Address
H Hold
N
Q Date Point of
0, Transportation Shipment
CO ❑ By Common a Carrier Destination
El Disinterment
Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Carleton Funeral Home 00276
Address
68 Maine Street, Hudson Falls, NY 12039
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
*' Address
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0- Permission is hereby granted to dispose of the human remains described above indicated. G
Date March 11, 2011 Registrar of Vital Statistics , (,`-Y„
Issued (signatur ` ��1
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of inn accordance� with this permit on:
Z Date of Disposition 3_16"It Place of Disposition '1 ^i kith.) C `,41-1'IK_.,
Ui (address)
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re (section) (lot number) (grave number)
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p71Z Name of Sexton or Person in Charge of emises r,)kce ,.� Q`^"Ott
W JJ (please print)
Signature ó4L_ Title Cat EN Itrd IN
(over)
DOH-1555 (02/2004)