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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last ' Sex
SHARON A DUBAY 1FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
07/28/2014 66 War or Dates
Ii— Place of Death Hospital. Institution
2 City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
pManner of Death Natural Undetermined ❑ Pending
at ® Cause El Accident 0 Homicide ❑ Suicide El CircumstancesInvestigation
WMedical Certifier Name Title
G SUNEET PAHWA MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number , Register Number
City,Town or Village City of Albany 101 1438
El Burial Date Cemetery or Crematory
ID Entombment 07/30/2014 PINE VIEW CREMAOTRY
®Cremation Address
QUEENSBURY, NY
Z Date Place Removed
O ❑ Removal and/or Held
and/or Address
H Hold
tI}
0 I Date Point of
Cl. Transportation i
CO 0 By Common Shipment
O Carrier Destination
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home ALEXANDER-BAKER F.H. 00037
Address
3809 MAIN ST., WARRENSBURG, NY 12885
I- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
eG
Q. Permission is hereby granted to dispose of the human remains desc . d above as indicate ,
Date 07/29/2014 Registrar of Vital Statistics �9 h- I(.. . . 25
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains
�off'the
/decedent identified above were,�jsposed of ipccordance ' this permit44)7.
Z Date of Disposition V/0'-�7 Place of Disposition (//414.. l/i lii
LU (address)
2
W
in
p (section) 000 ber) J (grave number)
wta
Name of Sexton o er n in of Premises f G (A-) imyi C.'
(please print) a �Signature / d Title r%,fy y S - -1 -
(over)
DOH-1555 (0212004)