Alfandari, Beverly M. N EW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Beverly M.Alfandari Female
Date of Death Age �Iferan of U.S.Armed Forces,
01/04/2020 77 Yearsr or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Mannerof Death �Natural Cause
W Accident Homicide 0 Suicide Undetermined Pending
U Circumstances Investigation
QW Medical Certifier Name Title
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 12
Burial Date Cemetery,Crematory or Facility Name
01/07/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
F, and/or and/or Held
N Hold Address
O
(L Date Point of
U) Transportation
0 by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition orto Whom
Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/07/2020 Registrar of Vital Statistics ,7olen rPaulFranck(E&-tronicaf So--e
(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:
H
Z Date of Disposition $ W Place of Disposition ZqwftL�
W
2 (address)
W
W (section) t number/ (grave number)
1313 Name of Sexton or Person in Charge of fmises
Z
pleas Tint)
W Signature /.✓' Title
DOH-1555(07/18)p 1 of 2
r
Public Health Law Sec. 4145(2b) 0 1 3 2-1 5
Receipt
Human remains of delivered on , 20
4
a Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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