Prescott, Ardra -# /6 a
NEW YORK STATE DEPARTMENT OF HEALTE1 *4 Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Ardra W Prescott Female
Date of Death Age If Veteran of U.S.Armed Forces,
3/20/20136 85 War or Dates
1— Place of Death Hospital, Institution
W' City ,Town or Village City of Albany or Street Address Albany Medical Center
p Manner of Death ® Natural Undetermined ❑ Pending
W' Cause ❑ Accident ❑ Homicide ❑ Suicide ❑
Circumstances Investigation
W Medical Certifier Name Title
i3 Nigam Ankesh MD
Address
43 New Scotland Avenue Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 581
Date Cemetery or Crematory
❑ Burial 3/22/2013 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
O 0 and/or Address
H Hold
CO
a' Transportation Date Point of
co By Common Shipment
O' Carrier Destination
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Renterment
Permit Issued To Registration Number
Name of Funeral Home Jillson Funeral Home 00885
Address
46 William St Whitehall, NY 12887
—' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ceAddress
W
d Permission is hereby granted to dispose of the human remains described above as indicated.
Date 3/21/2013 l Registrar of Vital Statistics D�"^��- �.
Issued (signature)
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:
Fi Date of Disposition 3-js t3 Place of Disposition R 1ltiv C ilw-c.f Ocii.6%.,
w (address)
2
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(section) .. (lot number) (grave number)
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Name of Sexton or Person in Charge of Premises Gs c'eopitt-
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(please print)
Signature 4 "�S Title ceorwL
(over)
DOH-1555 (02/2004)