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Davis, Donna Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donna Ann Davis Female Date of Death Age If Veteran of U.S.Armed Forces, 11/13/2023 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address St Peters Hospital 'p Manner of Death ❑X Natural Cause Accident Ei Homicide El Suicide Undetermined El Pending ✓ Circumstances Investigation W Medical Certifier Name Title O Sulaiman Hasan MD Address 315 S Manning Blvd,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 2765 Burial Date Cemetery,Crematory or Facility Name 11/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held - Hold Address 0 Date Point of (1)❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/21/2023 Registrar of Vital Statistics Retry Bartholomew(ECectronica(Cy Signed) (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: W Date of Disposition ��ZS'� Ric Place of Disposition e e Bak :ca.d ress/Ncc (section) f number) (grave number) SName of Sexton or Person in Charge of remis s Z (please print) W Signature L- / Title i DOH-1555(07/18)p 1 of 2 1 ._... 6 Public Health Law Sec. 4145(2b) Receipt i Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#