Levo, Louise NEWYORK STATE DEPARTMENT OF HEALTH BUriat - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Louise Levo I Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/27/2020 92 Years War or Dates
II.— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Mary's Haven
W
p Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
0 Robert Nielson MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 55
Burial Date Cemetery,Crematory or Facility Name
01/28/2020 Pine View Crematory
Entombment Address
KJ Cremation Queensbury Town,New York
❑Donation
� �Removal Date Pl ace Removed
and/or and/or Held
~N Hold Address
O
d Date Point of
N ❑Transportation
p 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 or to Whom
l— Remains are Shipped,If Otherthan Above
Address
Ir
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/28/2020 Registrar of Vital Statistics ,74a rPau,( ranck(EYectronicaQ Stgned,
(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 jr
'I
Z Date of Disposition 11110 70 Place of Disposition U6M 1
W (address)
2
W
N (section) (lot number) (grave number)
cc
0 TA-
Name of Sexton or Person in Charge Premises IJ
/ ase print Z
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013 2 S 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#