Woods, Michelle D I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michele D.Woods Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/01/2022 57 Years War or Dates reserves
Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address Albany Medical Center Hospital
• Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide �Undetermined Pending
W U Circumstances Investigation
W Medical Certifier Name Title
a Alon Jacobs-Friedman NP
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0333
ElBurial Date Cemetery,Crematory or Facility Name
02/04/2022 Pine View Crematory
Entombment Address
ElCremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
co ❑Transportation Shipment
p by Common
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinlerment
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
I.— Remains are Shipped,If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/03/2022 Registrar of Vital Statistics Dante&S y'illerpie(E/ctronicallySigned)
(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:
ZW Date of Disposition a,~4—.Z ,3
o� . Place of Disposition j 11;�,,v or)/2 (address)
W
N CC (section) (lot number) (grave number)
O• Name of Sexton or Per • in Charge Premises J c(/�rG�' Sfx t It
Z (please print)
W Signature / l.,)//?'' �`�'� Title C r!'°100(
DOH-155•': 18)ptof2
O,
Public Health Law Sec. 4145(2b) r s
0 1 5118
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#