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Duell, Kathleen M
3 gs` NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen M Duell Female Date of Death Age If Veteran of U.S.Armed Forces, 04/27/2021 54 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital W Manner of Death © W Natural Cause Accident El Homicide El Suicide El Undetermined Pending Circumstances Investigation IliQ Medical Certifier Name Title Riju Banerjee Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1144 Burial Date Cemetery,Crematory or Facility Name 05/03/2021 Pineview Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed o and/or and/or Held F-N Hold Address 0 a.U) ❑Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/29/2021 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: I— Z Date of Disposition S 13)71 Place of Disposition � („_ Zt ILI (address) W CC N (section) (lot number) (grave number) O Name of Sexton or Person in Charge of P mises �,i(p'�-- n Z se print) W Signature Title fetr 1< DOH-1555(07/18)p 1 of 2 ^ 4 Public Health Law Sec. 4145(2b) 1 4 1 Receipt Human remains of / delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# '