Calabrese, Emma 17
NEW YORK STATE DEPARTMENT OF HEALTH * '4 5
Vital Records Section 4 Burial - Transit Permit
Name First Middle Last Sex
Emma Elizabeth Calabrese Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/23/2012 17 War or Dates No
I— Place of Death Hospital, Institution
WCity,Town or Village City of Albany or Street Address Albany Medical Center Hospital
p Manner of Death Natural
❑ Accident ❑ Homicide ® Suicide Undetermined r-i❑ Pending
la ❑ Cause
Circumstances Investigation
W
Medical Certifier Name Title
p; Timothy Cavanaugh Coroner
Address
112 State Street Albany, NY 12207
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1815
Date Cemetery or Crematory
❑ Burial 09/27/2012 Pine View Crematorium
❑ Entombment Address
® Cremation
Queensbury, NY / "1
Date Place Removed
Z'' Removal and/or Held
2 ❑ and/or Address
Hold
N
d'' Transportation Date Point of
U) ❑ By Common Shipment
p Carrier Destination
❑ Disinterment
Date Cemetery Address
Date Cemetery Address
El Reinterment
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
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2` Address
W',
Q•' Permission is hereby granted to dispose of the human remains described above as indicated.
Date 09/25/2012 Registrar of Vital Statistics 42L'2 .L1 �
1- .•r al
Issued (signature) SGtJ
District Number 101 Place City of Albany, NY 140 It
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z; Date of Disposition 10I3lit Place of Disposition �"„.eol�W (/ #i1'—
tu (address)
W
U)
CG (section) , (lot number) e. (grave number)
0
0
W' Name of Sexton or Perso in Charge of Prem. es d11 Pr► tt
(please print) /
Signature Title CC(iM Ara.
(over)
DOH-1555 (02/2004)