Loading...
Holcomb, Grace t NEW YORK STATE DEPARTMENT OF HEALTH g, - 110 Vital Records Section Burial - Transit Permit -, Name First Middle Last Sex Grace M.Holcomb Female ,, Date of Death Age If Veteran of U.S. Armed Forces, „ 12/06/2018 74 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Albany Street Address Albany Medical Center Hospital qi Manner of Death©Natural Cause ❑Accident El Homicide ❑Suicide 17❑Undetermined 17❑Pending rcrm, Circumstances Investigation Medical Certifier Name Title Christopher Wang MD Address ` 43 New Scotland Ave,Albany,New York 12208 I Death Certificate Filed District Number Register Number City, Town or Village Albany 0101 2715 {_• i—i❑Burial Date Cemetery or Crematory 12/13/2018 Pineview Crematory = ❑Entombment Address 1®Cremation Queensbury, New York Date Place Removed Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier , '❑Disinterment Date Cemetery Address `' Date Cemetery Address 1, ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home Inc 00885 -• Address 46 Williams Street,Whitehall Village, New York 12887 P Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address w. Permission is hereby granted to dispose of the human remains described above as indicated. • Date Issued 12/10/2018 Registrar of Vital Statistics 1ianierreS Cgi((espie(E(ectronica((ySigned) (signature) vi District Number 0101 Place Albany, New York rii 'i I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition IZ 113 I i t Place of Disposition file LION.— ,::: (address) (section) 4 (lot number)S (grave number) Name of Sexton or Person in Charge o Premises [ i s 4.41 J�, (plese print) Signature (� Title (Iif11101_ (over) DOH-1555 (02/2004)