Schultz, Joyce \ Y
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joyce Margaret Schultz Female
Date of Death Age If Veteran of U.S. Armed Forces,
8/24/2018 76 War or Dates NA
F...+ Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs,NY Street Address Mary's Haven
W Manner of Death IT Natural Cause [—Accident E Homicide Ell Suicide n Undetermined ' Pending
Circumstances Investigation
a Medical Certifier Name Title
Mark Hoffman MD
Address
100 Park St. Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs NY q j fji 1-7 n
®Burial Date Cemetery or Crematory
El Entombment August 29,2018 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
�' Hold
N
0 Date Point of
yT Transportation Shipment
a by Common Destination
Carrier
E Disinterment Date Cemetery Address
ri Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
l � Remains are Shipped, If Other than Above
2 Address
te
a Permission is he eby anted to dispose of the human rem ' cr' ed eve indicated.
Date Issued �,,� I "6 Registrar of Vital Statistics I -
(signature)
District Number Li 01 Place SAQ SVTO L Jy-. SNX--teli(.4_5
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 8/29/201 8Place of Disposition pine Vi Pw r'emPtPry Queensbury
W (address)
N Mohawk 121 -A 1
IX
(section) (lot number) (grave number)
Z Name of Sex n or Person in Charge of Premises Connie Goedert
(please print)
W Signature .R Title Cemetery Superintendent
(over)
DOH-1555(02/2004)