Hutson, Eileen t # tf17
NEW YORK STATE DEPARTMENT OF HEALTH .� Burial - Transit Permit
Vital Records Section
gii Name First Middle Last Sex
Eileen G. Hutson Female
Date of Death Age If Veteran of U.S. Armed Forces,
06 / 08 / 2016 6S:. •War or Dates N/A
P• lace of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address 303 Jefferson St.
g Manner of Death®Natural Cause E Accident 0 Homicide C Suicide �Undetermined �Pending
Ili Circumstances Investigation
0.
al Medical Certifier Name Title
44. Susan M. Muller MD
gi Address
Fii 119 Lawrence St, Saratoga Springs, NY 12866
<'> Death Certificate Filed District Nu ber Register Number
City, Town or Village Saratoga Springs Q-[ o 9
0 Burial Date �^ Cemetery orematory
Entombment (L/ / S / / Pine View Crematory
Address
.Ni eik Cremation 21 Quaker Road, Queensbury, NY
MDate Place Removed
4.4❑Removal and/or Held
iiii and/or Address
Hold
Date Point of
Q Transportation Shipment
• by Common Destination
ip Carrier
itiliQ Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
P• ermit Issued to Registration Number
N• ame of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
tk Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
;f
i
Permission is hereby ranted to dispose of the human remain 'be abome ' icated.
3 Date Issued (p I� Registrar of Vital Statistics
(signature)
42 District Number (.4 'ot Place Saratoga Springs , New York
'' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
$11 Date of Disposition 4 I S(((. Place of Disposition e,�U... Imhofi..
(address)
VI
CC (section) dfrt
(!pt nymber)r`.. (grave number)
Name of Sexton or Person in Charge of Premises L. .✓
Zr (pletise print)
Signature Title
(over)
DOH-1555 (02/2004)