Brown, Pamela I 14 11 .3 Z)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
PAMELA ANN BROWN FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
05/20/2014 72 War or Dates
Place of Death Hospital, Institution
Cit ,Town or Villa e Cit of Alban or Street Address ALBANY MEDICAL CENTER
Manner of Death ® Natural ID Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Cause Circumstances Investigation
Medical Certifier Name Title
MICHAEL SIKIRICA MD
, Address
, 112 STATE ST., ALBANY NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 973
Date Cemetery or Crematory
❑ Burial 05/20/2014 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date 1 Place Removed
Z Removal and/or Held
P... ❑ and/or Address
H"" Hold
CO
Date Point of
il Transportation Shipment
❑ By Common - Destination
0 Carrier
❑ Disinterment Date Cemetery Address
❑ Date Cemetery Address
Reinterment
--, Permit Issued To Registration Number
Name of Funeral Home SINGLETON SULLIVAN POTTER F.H. 01596
- Address
407 BAY RD QUEENSBURY NY 12804
Name of Funeral Firm Making Disposition or to Whom
t't. . Remains are Shipped, If Other than Above
Address
q s
Permission is hereby granted to dispose of the human remains des 'bed above as ind' ted.
Date 05/21/2014 Registrar of Vital Statistics -' ' 1 Q .. IQ(tL( /
Issued (signature)
A� 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:
li Date of Disposition S-' ZZ.-ihl Place of Disposition `1 0-40O„__
ua (address)
tu
OTC.
0 (section) n (lot number) (grave number)
ca
Name of Sexton or Person in Charge of PremisesIli t,i> . 5VJk
4 (please print) 1
Signature Title C ..
(over)
DOH-1555 (02/2004)