Robinson, Darlene Nov 12 2014 3:37PM HP FaxHam Furies;- Hone 5184896513 -- puye 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital.Records Section Burial - Transit Permit
<,` Nate First Middle - 'Last • Sex '
: : • Darlene Anne • Robinson Female
f ; Date of Death Age. If Veteran of U.S. Armed Forces,
11 / 11 / 2014 s8 War or Dates . No
i Place of Death Hospital, Institution or ..
City,Town or Village City of Albany Street Address: , Albany Medical .Center 8oepital
iiiv Manner of Deathwho Natural Cause ID Accident El Homicide .D Suicide .u Undetermined n Pending
Circumstances Investigation
rrc Medical Certifier Name title
°`•: Yefim Yushvayev-Cavalier H.D.
h Address .
AMCH, 43 New Scotland Ave, Albany, NY 12208
>`< Death Certificate Filed District Number Register Number
1! City,..Town or Village city of Albany 0101 .
131
Burial Date
11 / 12/ 2014 Cem•etery or Crematory
°Entombment Address Pine View Crematory
I MCremation Qu®an>gbury. New York
, Date Place Removed
Removal and/or Held
e and/or Address
:21 Hold
Date . Point of
fr,<['Transportation Shipment
by Common Destination
Carrier
• : ; Date Cemetery Address
Disinterment
a
'%.':° Date Cemetery Address
1.} [l Reinterment
-..''.1 Permit Issued to Registration Number
'x, Name of Funeral Home Alexander-Baker Funeral Home 00037
x;: Address
)'� 3809 Main Street, Warrensburg, NY 12885
. ti
6 .Name of Funeral Firm Making Disposition or to Whom
'';: Remains are Shipped, if Other than Above
Address
.a
�
`. I
70
Permission is hereby granted to dispose of the human remains described above as indi ed
x: 11/12/2014
Date Issued Registrar of Vital Statistics •
>, (signature) -
•
'. District Number el01 Place City of Albany , New York
..
.1�
q. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i . Date of Disposition li/1 b11y Place of Disposition „,. (ram
i-a ' (address)
Ebrt (section) /� (lotnurnb ) (grave number)
Name of Sexton or Person in Charge of Premises
A�
� %ease prim q .
.1:1:',
Signature a Title LW-OM/4
(over)
35 (02/2004)