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Nelson, Karen NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Karen Elenore Nelson Female Date of Death Age If Veteran of U.S. Armed Forces, 04/01/2014 68 years War or Dates Place of Death Hospital, Institution or Z City, T X XOt X X Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause El Accident El Homicide 0 Suicide El Undetermined ri Pending LU Circumstances Investigation ut Medical Certifier Name Title 3; Ayesha Sooriabalan M D Address 211 Church Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number `> City, TOWOOt XPWAX Saratoga Springs 4501 158 ©Burial Date Cemetery or Crematory 04/05/2014 Pineview Crematorium ❑Entombment Address :igi❑Cremation Queensbury N Y Date Place Removed Z Removal and/or Held 2❑and/or Address H Hold th O Date Point of 5 0 Transportation Shipment i3 by Common Destination Carrier Q Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number gi Name of Funeral Home Tunison Funeral Home 01730 fG Address 105 Lake Ave, Saratoga Springs, Ny 12866 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above 2 Address WI • Permission is hereby granted to dispose of the human re • es ibedov as indic ted. Date Issued 04/02/2014 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1Jit Date of Disposition 4/5/1 4 Place of Disposition Pine View Cemetery (address) t1 U3 Ondawa 3 D 2 CC (section) (lot number) (grave number) C? Connie L. Goedert et Name of Sex on or Person in Charge of Premises (please print)Superintendent Signature .�`� • • Title. _ (over) DOH-1555 (02/2004)