DeCrescente, Marilyn NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - ra$ Permit
Name First Middle Last Sex
MARILYN A. DECRESCENTE FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
4/24/12 58 War or Dates NO
I.; Place of Death Hospital, Institution
City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Manner of Death Natural ❑ Undetermined ❑ Pending
® Cause ❑ Accident ❑ Homicide ❑ Suicide Circumstances Investigation
Medical Certifier Name Title
13 GURPREET SINGU MD
Address
:, 43 NEW SCOTLAND AVENUE ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 832
❑ Burial Date Cemetery or Crematory
❑ Buombment 4/27/12 PINE VIEW CREMATORY
ElCremation Address
QUEENSBURY, NY
Z Date Place Removed
Removal and/or Held
Q ❑ and/or Address
Hold
V)
Date Point of
d Transportation Shipment
V) ❑ By Common
G Carrier Destination
0 Disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
' Permit Issued To Registration Number
Name of Funeral Home SINGLETON SULLIVAN POTTER FUNERAL HOME 01596
Address
L. 407 BAY RD. QUEENSBURY, NY
F- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
*' Address
III
CLP Permission is hereby granted to dispose of the human remain- described above as in icate
Date 4/25/12 ,
Issued Registrar of Vital Statistics JZ .e)
(signature)
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:
Z Date of Disposition linI11_ Place of Disposition .�O .7 CM/40rt, .,
(address)
w
N
rZ (section) (lot number) (grave number)
0 _
a
WName of Sexton or Person in Charge of Premi es f ks ,.� sore
Signature 4 (please print)
Title Cdt,/MO 2,
(over)
DOH-1555(02/2004)