Macero, Donna NEW YORK STATE DEPARTMENT OF HEALTH v Sy(I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donna L. Macero Female
Date of Death Age If Veteran of U.S. Armed Forces,
7/22/2015 60 War or Dates 3/22/1974 - 02/25/1976
p- Place of Death Hospital, Institution or &- tdty- VA- Mel.1-a-3-G -1/4._
W City, Town or Village Albany Street Address 113 Hollanci Ave.,Albany,NY
l0tJ Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending
Circumstances Investigation
tu Medical Certifier Name Title
Ishtpreet Uppal MD
Address
113 Holland Ave.,Albany,NY 12208
Death Certificate Filed District Number Register Number
r' City, Town or Village Albany 198 110
El Burial Date / Cemetery or Crematory /�
['Entombment �6 � 7aoi � ` i n..e y`ram=..., C�-�e'r"`-�-+'.
Address
ANICremation be a--As 4,r Pe..- ) Y'"1
Date i3 t Place Removed
Removal and/or Held
and/or Address
M= Hold
CO
O Date Point of
OS 0
Transportation Shipment
0 by Common Destination
Carrier •
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Hare Inc 00448
Address
7 Sherman Avenue, Cornith, New York 12822
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
tt
UI
Permission is hereby granted to dispose of the human re ai s describ above as indicated.
Date Issued 7/22/2015 Registrar of Vital Statis i s Ar ington
(signature)
District Number 198 Place VAMC,113 Holland Ave.,Albany,NY 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
kU▪ Date of Disposition )--a,-g Place of Disposition ►".'ne v.,e,,, Cre„"c4ar.ly
2 (address)
Ili
ilk
CC (section (lot number) (grave number)
Q
0 Name of Sexton or Person in Charge of Premises IA `rcrtiLy Bic/riel
(please print)
) Signatures e Title Cne►rc o,y A,i-4.
(over)
DOH-1555 (02/2004)