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Kearns, Cherylin G # 33g NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cherylin G Kearns Female Date of Death Age If Veteran of U.S.Armed Forces, 04/08/2021 70 Years War or Dates Place of Death Hospital,Institution or ZCity,Town or Village Albany Street Address Albany Medical Center Hospital 0 Manner of Death ©Natural Cause El Accident Homicide 0 Suicide 0 Undetermined 0 Pending W Circumstances Investigation V alMedical Certifier Name Title 0 Usman Naseer Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0967 0 Burial Date Cemetery,Crematory or Facility Name 04/09/2021 Pineview Crematorium Entombment Address X❑Cremation Queensbury Town,New York EiDonation Z❑Removal Date Place Removed and/or and/or Held pN Hold Address dDate Point of (0 Transportation Shipment G by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom i... Remains are Shipped,If Other than Above S Address fr a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/09/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- f W Date of Disposition �I I5 I1( Place of Disposition A,,,�I�- Orr, (address) W NCC (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises h r"}it.- 3h.,,A'41^ z 6 (Male print) IliTitle �/�4ti"14?al2 Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01470 Receipt 1 Human remains of , • , • - delivered on 1,,/ , 20 Pine View Cemetery Representing the funeral home name4oy ba1 permit Official Funeral Directors Reg.or License#i