Corbett, Joan NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transr ermit
Vital Records Section
Name First Middle Last Sex
JOAN VIRGINIA CORBETT FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
02/13/2015 85 War or Dates
Place of Death Hospital,Institution
City,Town or Village City of Albany or Street Address ` ALBANY MEDICAL CENTER
Manner of Death Natural Undetermined Pending
® [�0 Accident ❑ Homicide ❑ Suicide ❑
Cause Circumstances Investigation
Medical Certifier Name Title
NATHANIEL NOWACKI MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Registe"Number
City,Town or Village City of Albany 101 350
Date Cemetery or Crematory
❑ Burial 02/17/2015 PINEVIEW CREMAOTRY
0 Entombment
Address
Cremation QUEENSBURY, NY
40, Date Place Removed
Removal and/or Held
❑ and/or
Address
Hold
Date Point of
Transportation Shipment
x ❑ By Common
Carrier Destination
�3'k(
M 0
Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home M.B. KILMER F.H. 01078
Address
136 MAIN ST SO GLENS FALLS NY 12803
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 des ' above as indi t) /
Date 02/13/2015 Registrar of Vital Statistics (1rQQ_'
Issued (signs ure)
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:
Date of Disposition Z1l1I I'S Place of Disposition 1e01). Gr eiti--
(address)
(section) � (lot number) grave number)
Name of Sexton or Person in Ch rge of Premises �i' as) Soo
(please print) I
1. , l 'is►,
Signature Title
(over)
DOH-1555(02/2004)