Willett, Sadie NEW YORK STATE DEPARTMENT OF HEALTH \2 \ Burial - TrarlSlzermlt
Vital Records Section
Name First 11Cdle- ~' Last Sex
SADIE MOONEAN WILLETT FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
r2/29/12 75 War or Dates 1959-1962
.,,i Place of Death Hospital, Institution HOSPICE INN AT ST. PETER'S
City,Town or Village City of Albany or Street Address HOSPITAL
ril Manner of Death Natural Undetermined Pendin
® Cause ❑ Accident IDHomicide ID Suicide ❑ ❑ g
11770
Circumstances Investigation
Medical Certifier Name Title
PATRICK TIMMINS MD
Address
319 S. MANNING BLVD. ALBANY, NY 12208
j Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 437
❑ Buial Date Cemetery or Crematory
r
❑ Buombment 3/5/12 PINE VIEW CREMATORIUM
® Cremation Address
QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
❑ and/or Address
Hold
07
0, Date Point of
- Transportation
`, ElBy Common Shipment
CrlCarrier Destination
,' ❑ Disinterment
Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued To Registration Number
Name of Funeral Home STAFFORD FUNERAL HOME, INC. 01624
Address
riTa 90 MONTCALM ST. LAKE GEORGE, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains escribed aboeve as indica d.
ot Date 3/1/12 '
Issued (signature)Registrar of Vital Statistics R/
District Number 101 Place City of Albany, NY
glii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z Date of Disposition (k4LL 71 At Place of Disposition &Li Cni*+ifw
(address)
(section)E.
04
ce
(lot number) (grave number)
Gt C
Name of Sexton or Person in Charge of Premises At St+nr
tu
I- (please print)
Signature ii9L
Title c tEIMI}tOQ1
(over)
DOH-1555(02/2004)