Alger, Nancy Washock lik bl bbuoo r r ,r It1 y
12
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
•s Name First Middle Last Sex
Nancy E. Alger Female
Date of Death Age If Veteran of U.S.Armed Forces,
07 104 / 2014 77 War or Dates no
1=- Place of Death '• Hospital, Institution or
Z City, Town or Village Albany Police Dept. Adi Street Address Albany Medical Center Hospital
Manner of Death® Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined ri Pending
it! Circumstances Investigation
j,j Medical Certifier Name Title
i Amarante, Matthew M.D.
`
24
y' Address
AMCH 43 New Scotland Ave., Albany, NY 12208
v"i Death Certificate Filed I District Number t Register Number
`">< City, Town or Village Albany Police Dept. VI 1
f ❑Buriai Date ' Cemetery or Crematxy
<> ❑Entombment
-7/-2// I P/4,c pe....." c.:re..i.a.,A,--—7
�� Address /
vP 11Cremation Cj7 u e..E•4s I r y / /1--"/
i<>: Date ) Place Removed
O.❑Removal / / and/or Held
and/or Address
aHold
Date Point of
Ix Q Transportation Shipment
O by Common Destination
Carrier
kiti Date Cemetery Address
A`Q Disinterment
Q Reinterment Date Cemetery Address
Permit Issued to J Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
>. Address
"- 3809 Main St., Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
M Address
1t
' Permission is hereby granted to dispose of the human remain. ibed ove as indicated.
''` Date Issued 7/6/1 4 Registrar of Vital Statist of s--•------
s" �.� (signature)
,Ni.
ND; District Number /6/ Place Albany V osice pt, any , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Or►
Date of Disposition 7 ,�1i1 i Place of Disposition ( ,utJ titw- v...-
2 (address)
La
i= (section) jot number) e. (grave number)
g Name of Sexton or Person . Charge f Premises -. 'is ntt(i-
Z (pi base print) .
Signature Title 007104
(over)
DOH-1555 (02/2004)