Gooden, Alexis Leigh Davis -"k tic?
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Alexis Leigh Davis Gooden Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/11/2021 35 Years War or Dates
1_ Place of Death Hospital,Institution or
WCity,Town or Village Watervliet Street Address 3rd Avenue,Watervliet,New York 12189
Manner of Death Natural Cause ❑X Accident ❑Homicide 1=1 Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Timothy Cavanaugh Coroner
lddress
112 State Street,Albany,Npfw York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Watervliet 0103 8
❑Burial Date Cemetery,Crematory or Facility Name
02/17/2021 Pine View Crematory
❑Entombment Address
ICremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
0. Date Point of
U) 11 Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
EiDisinterment
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/17/2021 Registrar of Vital Statistics Janice Marie Meyer(Electronrcaf Signer)
(signature)
District Number 0103 Place Watervliet, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Z 1 i 1?t Place of Disposition g_11._ or--
2 (address)
W
CC CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Pr es t•�y it}
Z (please int) ��
W t
Signature Title l`� b'fi��C'"
DOH-1555(07/18)p 1 of 2
j ' . .. A latm ✓ I A.55ii
i Public Health Law Sec. 4145(2b) --
Receipt
Human remains of - delivered on , 20
Pine View Cemetery Representing the funeral home named cpri burial permit
Official Funeral Directors Reg.or License#