Campbell, April NEW YORK STATE DEPARTMENT OF HEALTH 10
Vital Records Section }. . f-ii. Burial - Transit Permit
Name First Middle Last Sex
April Dawn Campbell Female
Date of Death Age If Veteran of U.S. Armed Forces,
7/9/ 2012 32 War or Dates No
I Place of Death Hospital, Institution or
W City, Town or Village City of Albany Street Address Albany Medical Center
Manner of Death uicNatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
MI Circumstances Investigation
al Medical Certifier Name Title
CI Neil Yager, MD
Address
43 New Scotland Avenue Albany, NY 12208
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 101 tr3
0 Burial Date Cemetery or Crematory
07/17/2012 Pine View Crematorium
i`< ['Entombment Address
®Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
i= Hold
CA _
O Date Point of
ineL❑Transportation Shipment
C3 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main Street, PO Box 67, Hudson Falls, NY 12839
iiR Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
st
t
P` Permission is hereby granted to dispose of the human r mains described bove as indicated.iij c
Date Issued "1 1'a-�L� Registrar of Vital Statistics � e � _ (2.q ` t/� .S
(signature) C
District Number �,c_-) k Place `
6 bct(\L�
a.: I certify that the remains of the decedent identified a ove were disposed of in a cordance with this permit on:
Z p
LU Date of Disposition ')-icy11 Place of Disposition �I/►.4Uvv (t or w•
(address)
W
i/?
C (section) / (lot number) c (grave number)
CName of Sexton or Person in Charg of Premises Cn ri S r �)14.
2 please print)
iLi Signature Zirlitig.....- -- Title CAL NATO/I,
9
(over)
DOH-1555 (02/2004)