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Yawman, Karen Ann , 1 510 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen Ann Yawman Female Date of Death Age If Veteran of U.S.Armed Forces, 06/19/2021 58 Years War or Dates Place of Death Hospital,Institution or HaZ City,Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title CI Muhammad taimoor Iftikhar Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1560 ElBurial Date Cemetery,Crematory or Facility Name 06/22/2021 Pine View Crematory Entombment Address ail Cremation Queensbury,New York ❑Donation Z r—IRemoval Date Place Removed 0 Liand/or and/or Held tN Hold Address A. Date Point of N ❑Transportation Shipment by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment 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 tRemains are Shipped,If Other than Above 2 Address t1 W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/21/2021 Registrar of Vital Statistics Danielte S GiCCespie(ECectronicaCty 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: Z Date of Disposition IP 111114 Place of Disposition �r,.i L prt.-- 22 (address) 111 NtE (section) X (lot number) (grave number) 8 Name of Sexton or Person in Charge of P ises r`6 (plasm print) /� in *IOC Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014878 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#