Berube-Burnell, Alexandria + r
NEW YORK STATE DEPARTMENT OF HEALTH 670
Bureau of Vital Records Burial - Transit Permit
Name First Middle
Alexandria Berube-Burnell Last Sex
Date of Death Age If Veteran of U.S.Armed Forces, Female
08/19/2022
War or Dates
F. Place of Death
WCity,Town or Village Albany Hospital,Institution or
Manner of Death Street Address Albany Medical Center Hospital
CW? El Natural Cause Accident Homicide E Undetermined
Suicide ❑Pending
aLIJ Medical Certifier Name Circumstances Investigation
Title
Amanda Vinner
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number
City,Town or Village 0101 Register Number
_ 1946
Burial Date Cemetery,Crematory or Facility Name
08/22/2022 Pine View Crematorium
Entombment
Address
Cremation Queensbury Town,New York
DDonation
Date Place Removed
0❑Removal
H and/or and/or Held
-- Hold Address
0
O. Date Point of
co❑Transportation
5 by Common Shipment
Carrier Destination
EjDisinterment Date Cemetery Address —
Reinterment Date Cemetery Address
Permit Issued to
Name of Funeral Home Carleton Funeral Home Inc Registration Number
Address 00281
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
�.. Remains are Shipped,If Other than Above
a Address
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/22/2022 Registrar of Vital Statistics 'Dan effeS gi(Cespie(ECectronicaltySigned)
(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:
Date of Disposition ?/1}[?-2,... Place of Disposition j};,,� V:� Gre,,,,gkpy
T�' (address)
it
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Te-ism t'✓Y -S`(,v;TA,S
Z (please print)
lU Signature Title �.ftm_4
DOH-15551011i81 p 1 of 2
+ ,d_
I Public Health Law Sec. 4145(2b)
1
Receipt
r
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named pn tlurial permit
1 Official Funeral Directors Reg.or License#