Francis, Bernadette F. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Bernadette F.Francis Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2019 70 Years War or Dates
II.— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W
`p Manner of Death �Natural Cause ❑Accident Homicide Suicide Undetermined Pending
V Circumstances Investigation
LU Medical Certifier Name Title
Enrico Bravo MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 681
Burial Date Cemetery,Crematory or Facility Name
12/19/2019 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
zRemoval Date Place Removed
and/or and/or Held
H N Hold Address
O
IL Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i.— Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2019 Registrar of Vital Statistics John PaulFranck(ElectronicalfySoned)
(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
WDate of Disposition �,�1�_L� Place of Disposition .ie t C
l (address)
W
N
M (section) / (lot number) (gravenumber)
0 Name of Sexton or Person in Charge of P emises
Z (please print)
W Signature aL1T���, Title '��
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01 317-1_
Receipt
Human remains of delivered on , 20
Pine/View Cemetery Representing the funeral home named cn burial permit
Official Funeral Directors Reg.or License#