Powell, Abrielle ..• t If 7513
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
''' Name First Middle Last Sex
ABRIELLE POWELL FEMALE
. Date of Death Age If Veteran of U.S.Armed Forces,
10/15/2015 4 DAYS War or Dates
F. Place of Death Hospital, Institution
Z. City ,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
WW Manner of Death Natural Undetermined Pending
' ® Cause ❑ Accident ❑ Homicide El Suicide ❑ Circumstances ❑ Investigation
W' Medical Certifier Name Title
CI:; MEREDITH MONACO-BROWN MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 2170
Date Cemetery or Crematory
❑ Burial 10/19/2015 PINEVIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q, ❑ and/or Address
- Hold
Q Date Point of
a Transportation Shipment
❑ By Common Destination
Cl. Carrier
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home BARTON MCDERMOTT FH 00141
Address
9 PINE ST CHESTERTOWN NY 12817
NName of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2' Address
Ce
LU
a Permission is hereby granted to dispose of the human remains des ed above as m di ted.l
Date 10/16/2015 Registrar of Vital Statistics �. �-'C `�`� S
Issued (signature) , 1 - I
District Number 101 Place City of Albany, NYit 4 * •
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
li Date of Disposition to/Iq Its Place of Disposition emit.,�� c'''i'fa�"''
Uj (address)
Lti
Ce (section) (lot number) (grave number)
0
w' Name of Sexton or Person in Charge of Premises dt,i Stems
(please print)
4
Signature Title re f1
(over)
DOH-1555 (02/2004)