Kaiser, Joyce NEW YORK STATE DEPARTMENT OF HEALTH o > Ni It 13
Vital Records Section Burial - Transit Pe mit
Name First Middle Last Sex
Joyce A. Kaiser Female
Date of Death Age If Veteran of U.S.Armed Forces,
February 27, 2014 71 War or Dates No
t— Place of Death Hospital, Institution
W City ,Town or Village City of Albany or Street Address Albany Medical Center
WManner of Death Natural Undetermined Pending
® Cause El Natural El Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
JJ Medical Certifier Name Title
CI William Raible MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 412
Date Cemetery or Crematory
❑ Burial March 3, 2014 Pine View Crematory
E Entombment Address
® Cremation
Queensbury, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or
Address
Hold
N
0 Date Point of
Q. Transportation Shipment
V) ❑ By Common
8 Carrier Destination
❑ Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ce
w
- Permission is hereby granted to dispose of the human remains described ab ve as indicated.
Date February 28, 2014 Registrar of Vital Statistics C �� "
Issued (sign tur
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 3/y illi Place of Disposition 'TetgAJ Ce.-o jr,,,-.
w (address)
2
w
co
ce (section) of number) (grave number)
0
G
WName of Sexton or Person in Charge of Premises i<� r —cult
(please print)
Signature 4 I - Title alp
(over)
DOH-1555 (02/2004)