Di Benedetto, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH .'
Vital Records Section Burial - Transit Permit
it Name First Middle Last Sex
Elizabeth DiBenedetto
Female
14
• Date of Death Age If Veteran of U.S. Armed Forces,
11/08/2017 44 Years War or Dates
44,
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death rei Natural Cause p Accident 0 Homicide El Suicide El Undetermined riPending
Circumstances Investigation
Medical Certifier Name Title
Rodney Ying MD
ii Address
, 211 Church St,Saratoga Springs,New York 12866
' Death Certificate Filed District Number Register Number
_ City, Town or Village Saratoga Springs 4501 551
t
Date Cemetery or Crematory
❑BUrlal
11/10/2017 Pine View Crematory
❑Entombment
`' Address
'34 ®Cremation Queensbury Town, New York
: Date Place Removed
❑Removal and/or Held
and/or Address
Hold
0 Date Point of
Q Transportation Shipment
.44
by Common Destination
° Carrier
El Disinterment Date Cemetery Address
F
t• Q Reinterment u Date Cemetery Address
it Permit Issued to Registration Number
4 Name of Funeral Home Compassionate Funeral Care Inc 00364
15 Address
lit 402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
is;,
.z Date Issued 11/10/2017 Registrar of Vital Statistics John PEranck ECectronica1TySigned
(signature)
District Number Place
4501 Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition II /1S(n Place of Disposition ? '-" ( G`
°-4 (address)
.1
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises /r►aL t/...4t.
(pi ase print)
44 Signature Title (17 4 T
(over)
DOH-1555 (02/2004)