Rogers, Suella Jane y-
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NEWYORKSTATEDEPARTMENTOFHEALTH tt 137
Bureau of Vital Records Burial - Transit Permit
Name First Middle
Suella Jane Rogers Last Sex
Date of Death Female
Age If Veteran of U.S.Armed Forces,
08/06/2022 68 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address Albany Medical Center Hospital
Q Manner of Death Natural Cause
W x Accident Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
LU Medical Certifier NameCI Title
Matthew Collin
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1835
Burial Date Cemetery,Crematory or Facility Name
.." 08/10/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 0 Removal Date Place Removed
p and/or and/or Held
I.0 Hold Address
0
O. Date Point of
Cl):Transportation
C by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
jJReinterment Date Cemetery Address
-Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2022 Registrar of Vital Statistics EDanietTeSCir[espie(E(ectronica1TySigned)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1— y�.
W Date of Disposition gl it 1 ZZ Place of Disposition "I t-t
(address)
W
N (section) 4,.4.4L,r lot numb (grave number)
CC
Kart
g Nameof Sexton or Person in Charge of P miseslease print/
.--Z Zl Title C('/‘/AW l4-.
W Signature
DO11-15551o118)P 1 of 2
r
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
1
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#