Fitzgerald, Baby NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit S
Vital Records Section
Name First Middle Last Sex
BABY FITZGERALD FETAL
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2020 FETAL War or Dates
I- Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
W Manner of Death Natural Undetermined Pendin
❑ ❑ Accident ❑ Homicide ❑ Suicide ❑ ❑ g
W (FETAL) Cause Circumstances Investigation
WMedical Certifier Name Title
41 KERI BERLIN MD
Address
43 NEW SCOTLAND AVE
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 FETAL
Date Cemetery or Crematory
. Burial 01/21/2020 PINEVIEW CREMATORY
iEntombment Address
Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or Address
H Hold
CO
Date Point of
0. Transportation Shipment
U) ❑ By Common a Carrier Destination
0 Date Cemetery Address
Disinterment
El Reinterment
Cemetery Address
Reinterment
I
Permit Issued To Registration Number
Name of Funeral Home MB KILMER FUNERL HOME 01077
Address
123 MAIN STREET ARGYLE, NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
2
ir
it Permission is hereby granted to dispose of the human remains described above as indicated.
a. 01/21/2020
Date
Issued Registrar of Vital Statistics "` ` 7-`
(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:
Z Date of Disposition I/zZ I Zl Place of Disposition EJL /43tc._
W (address)
2
W
co
cc (section) lot number) (grave number)
O it--3:1,41t"ZName of Sexton or Person in Charge of Premises 41/+
please print) A
Signature Title (It If7 '
(OVER) DOH-1555 (02/2004)
v ,
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#