Banker, Judy k. it 4
NEW YORK STATE DEPARTMENT OF HEALTH CM
Vital Records Section Burial - Transit Permit
gi Name First Middle Last Sex
Judy Rae Banker Female"
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 02 / 2017 76 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Wesley Health Care Center
a Manner of Death
Natural Cause 0 Accident E Homicide C Suicide ❑ Undetermined 0 Pending
ILICircumstances Investigation
tu Medical Certifier Name Title
Jenny Romero MD
Address
3 Care Ln Saratoga Springs, NY 12866
gii Death Certificate Filed District Number 1 ,5D 1 Register Number�C
City, Town or Village Saratoga Springs `--t t
<;i Burial Date Cemetery or Crematory
Rii 02 / 03 / 2017 Pine View Crematory
:s0Entombment Address
iuii:i. Cremation Queensbury, NY
`_.> Date Place Removed
a❑Removal and/or Held
and/or
Address
Hold
M.
Date Point of
Q Transportation Shipment
C2 by Common Destination
Carrier -'
Q Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
iii Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
2
ILI
Permission is h re y granted to dispose of the human remai e rib ab°r ' dicated
Date Issued 2_3. 1- Registrar of Vital Statistics ! o
-- (signature)
District Number I V 1 Place Saratoga Springs , New York
Mi
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1101 Date of Disposition 713 ill Place of Disposition CA,Lk✓ l,w..ci fir,.,,,
(address)
Crill
til
(section) 7 (lot number) (grave number)
gName of Sexton or Person in Charge of Premises '. itAAsti
f r' , t'(pl ase print)
Signature /, Title `0+41
(over)
DOH-1555 (02/2004)