Feulner, Jane A I 56
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jane A Feulner Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/03/2021 85 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined Pending
C.) Circumstances Investigation
W Medical Certifier Name Title
Jessica Francis MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 1666
ElBurial Date Cemetery,Crematory or Facility Name
07/10/2021 Pineview Crematory
Entombment Address
0 Cremation Queensbury Town,New York
ElDonation
go
Removal Date Place Removed
and/or and/or Held
F—N Hold Address
0
Q. Date Point of
N 11 Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
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
f.. Remains are Shipped,If Other than Above
a Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/06/2021 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:
FrIA.
WDate of Disposition 7 IZ fZi Place of Disposition2 address)
CO
CC (section) (lotAr/mber) (grave number)
0ot
Name of Sexton or Person in Charge of P s `�'//[/�` �µ rf(please print)i
W Signature Gam Title lW
1,111
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 14 9 9
Receipt
Human remains of delivered on , 20
.. sa^ram
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#