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Graves, Betsey L. 614 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Betsey L.Graves Female Date of Death Age If Veteran of U.S.Armed Forces, 07/02/2021 80 Years War or Dates Place of Death Hospital,Institution or {iI City,Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death ©Natural Cause Accident El Homicide El Suicide 0 Undetermined 0 Pending Circumstances Investigation • Medical Certifier Name Title Spencer Lord MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 ❑Burial Date Cemetery,Crematory or Facility Name 07/03/2021 Pineview Crematorium Entombment Address ElCremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or et and/or Held Hold Address co Li Transportation Date Point of Es by Common Shipment Carrier Destination E Disinterment Date Cemetery Address Date Cemetery Address El Reinterment 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 Remains are Shipped,If Other than Above 5 Address tr Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/03/2021 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: Z Date of Disposition 7_3rze 24 Place of Disposition ?,yr,w,�,t/ ePe,reie'� (addres{/ (section) (lot number) (grave number) Name of Sexton or Per in C ge of Premises J� /to n 6444-4-1.-/Le (please print),. . Signature Title 'fan"' DOH-1555(07/18)p t df 2 Public Health Law Sec. 4145(2b) 0.14908 Receipt Human remains of ° ° delivered on , 20 - Pine View Cemetery Representing the funeral home named on..huKial,pertytit Official Funeral Directors Reg.or License#