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Schommer-Hoag, Debra Lee L1lio NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Debra Lee Schommer-Hoag Female Date of Death Age If Veteran of U.S.Armed Forces, 06/03/2021 67 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Albany Street Address Albany Medical Center Hospital a Manner of Death ©Natural Cause El Accident 0 Homicide El Suicide 11 Undetermined El Pending W Circumstances Investigation 8 Medical Certifier Name Title Wen Zheng MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1449 ❑Burial Date Cemetery,Crematory or Facility Name 06/07/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation Z El Removal Date Place Removed and/or and/or Held N Hold Address 0 Ca ❑Transportation Date Point of ®') by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/04/2021 Registrar of Vital Statistics lDaniell"e S C iCCespie(ECectronicafTySigned) (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: Date of Disposition (P I l l LI Place of Disposition ,+,c,L A d.-` ILI (address) ILl CD cc (section) /!ot numbber) C (grave number) 8 Name of Sexton or Person in Charge of Pre ' s l 1� ✓�.i( z (plea print) /� W Signature Title II c �"'� DOH-1555(o7/t8)p 1 of 2 Public Health Law Sec. 4145(2b) 1 4843 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#