Rodigue, Marianna IT
NEW YORK STATE DEPARTMENT OF HEALTH ' 3�
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marianna A. Rodrigue Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2015 71 War or Dates No
1- Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address Albany Medical Center Hospital
ca Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Ili Cause Circumstances Investigation
W' Medical Certifier Name Title
p Jessica Noonan MD
Address
43 New Scotland Ave. Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1050
Date Cemetery or Crematory
❑ Burial 05/18/2015 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z' Removal and/or Held
Q ❑ and/or Address
N Hold
CO
Date Point of
a Transportation Shipment
CO ❑ By Common Et Carrier Destination
❑ Disinterment Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
" Address
24 Church St. Lake Luzerne, NY 12846
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ce
IJJ
Cl- Permission is hereby granted to dispose of the human remains H crib above as indicated.
Date 05/15/2015 t -e, r
- 9
Issued Registrar of Vital Sta�tisSics ature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ii Date of Disposition 1161 IC Place of Disposition 'ex/IL 6wr+rlon, ..
W (address)
2
w
w
0 (section) (lot number) (grave number)
Ct Alfil -- 113-
Name of Sexton or Person in Charge of Premises
1.11 (please print)
ZSignature Title C �
(over)
DOH-1555 (02/2004)