Deeter, Karen r k it.7yL
NEW YORK STATE DEPARTMENT OF IEALTH
Vital Records Section Burial - Transit Permit
fr Name First Middle Last Sex
Karen Deeter Female
▪ Date of Death Age If Veteran of U.S. Armed Forces,
10/06/2017 78 Years War or Dates
• Place of Death Hospital, Institution or
it City, Town or Village Saratoga Springs Street Address Saratoga Hospital
C Manner of Death E j Natural Cause E Accident ❑Homicide 0 Suicide ❑Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
41 Carlos Ares MD
Address
• 211 Church St,Saratoga Springs,New York 12866
• Death Certificate Filed District Number Register Number
J City, Town or Village Saratoga Springs 4501 493
❑Burial Date Cemetery or Crematory
10/09/2017 Pine View Crematory
❑Entombment Address
1• ®Cremation Queensbury Town, New York
Date Place Removed
Z Removal and/or Held �*
• and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier _
Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
ti: Address
402 Maple Ave,Saratoga Springs,New York 12866
A Name of Funeral Firm Making Disposition or to Whom
N' Remains are Shipped, If Other than Above
2 Address
tL
'U
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/09/2017 Registrar of Vital Statistics JohnPTranck 'ElictronicallySigned-
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1.14 Date of Disposition Milli') Place of Disposition P ? (. Q1-o*t...
(address)
W.
Ce (section) A (lot number)4,,44,0
(grave number)
pl(r,Name of Sexton or Person in Charge of Premises,o, lease pri
• Signature l'-f Title liZ Mi19)!L
(over)
DOH-1555 (02/2004)