Pratt, Wendy Dec 15 2015 1:25PM HP FaxHans Funeral Home 5184896513 ` page 1 97(61°
NEW YORK STATE DEPARTMENT.OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Wendy • Sue Pratt Female
<� Date of Death Age If Veteran of U.S.Armed Forces,
12 / 13 / 2015 46 War or Dates N/A
Place of Death Hospital, Institution or
Z City,Town or Village City of Albany Street Address Albany Medical Center
El Manner of Death®Natural Cause 0 Accident ❑Homicide Suicide [�Undetermined 0 Pending
Circumstances Investigation
la Medical Certifier Name Titre
John Lansing D.O.
Address
AM,CN 42 New Scotland Ave.,Albany, NY 12208
Death Certificate Filed District Number I R inter N ber
City,Town or Village City of Albany 0101
(]E3urial Date Cemetery or Crematory
12 / 15 / 2015 Pineview Crematory
<, ❑Entombment Address
"t `PgCremation Queenabury, New York
Date Place Removed Removal and/or Held
and/or Address
t=' Hold
Date Point of
Q Transportation Shipment
C by Common Destination
: Carrier
Disinterment Date Cemetery Address
iii Ely Date Cemetery Address
ii ❑Reinterment
ii.0 Permit Issued to Registration Number
, Name of Funeral Home Alexander-Baker Funeral ,Rome 00037
Vi
<` Address
:rid 3809 Main St., warrensbuxg, NY 12885
0 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
11 Address
1
V,
rt Permission is hereby granted to dispose of the hum sins described above as indicated.
2L?}
•;:f Date Issued (zf/5/15 Registrar of Vital Statistic �,1p,',is,�, '� .. _O LL�(� i,QZ
,di - (signature) Q
District Number 0101 Place City of Albany , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tiii
ILI Date of Disposition /Z46-i 5 Place of Disposition R el e tJ,e iJ me,-4,yy
(eddre1s)
ILI
to
(section) Oct number) (grave number)
Name of Sexton r Pers n in Charge of Premises '3,,.-)�E-� �yrkt.�4.
Z„ Q (Please print) .
tU
:.,.:•„,,, Signature Title ���e'' '� `i Ss r S�
(over)
DOH-1555 (02/2004)