Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Hale, Baby A
11 NEW YORK STATE DEPARTMENT OF HEALTH 1 4 rt Vital Records Section Burial - Transit Permit Name First Middle Last Sex Baby Hale Fetal Date of Death Age If Veteran of U.S.Armed Forces, April 6, 2013 Fetal A War or Dates 1.- Place of Death Hospital, Institution Z City,Town or Vill City of Albany or Street Address Albany Medical Center W© Manner of Deat tiT' Natural Undetermined Pending ILICause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation W< Medical Certifier Name Title p Philip Clements MD Address 43 New Scotland Ave., Albany, NY 12208 Death Certificate Filed District Number RegisterNumber City,Town or Village City of Albany 101 P l , Date Cemetery or Crematory ❑ Burial April 10, 2013 Pineview 0 Entombment Address ® Cremation Queensbury, NY Date Place Removed Z' Removal and/or Held Q' ❑ and/or Address I— Hold 'rd Q Date Point of ri. Transportation Shipment Cl) ❑ By Common 6 Carrier Destination El Disinterment Date Cemetery Address ❑ Date Cemetery Address Reinterment Permit Issued To Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped, If Other than Above C4• Address W 13- Permission is hereby granted to dispose of the human remains described above indicated. 4Date April 8, 2013 Registrar of Vital Statistics L C t at Issued (signatur / 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: E'1 Z Date of Disposition 4+. 12 -0 Place of Disposition '"i- 1�� t 41 Cc' ^c leti ul^' w (address) W cn rt (section) i.-yi )1l'�1 w(lot number) (grave number) O j► 1 -Sh- o e WName of Sexton or Person in Charge of Premises t (please print) i Signature ( L LL.L. Title Gw ott (over) DOH-1555 (02/2004)