Boyd, Helen Marie a ' -NEW YORK STATE DEPARTMENT OF HEALTH � (Z2 Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Helen Marie Boyd Female
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 03 / 2020 80 War or Dates
}- Place of Death Hospital, Institution or
W City, Town or Village Saratoga Springs Street Address 15 Tompion Lane
0 Manner of Death® Natural Cause []Accident []Homicide �Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
John Delmonte, Jr. MD
Address
3 Care Ln #300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Nu ber
City, Town or Village Saratoga Springs `1
QBUflal Date Cemetery or Crematory
02 / 04 / 2020 Pine View Crematory
Q Entombment Address
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
0.
Hold
Date Point of
Transportation Shipment
fl by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human re escr'bad above as indicated.
Date Issued Registrar of Vital Statistic - T 73vw
(signature
District Number Place Saratoga Springs New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 216170 Place of Disposition (��.., /-4°�w—
(address)
(section) (lot number) (grave number)
` Name of Sexton or Person ip Chjtrge of7Preises (Alease print)9 Si nature Title AhR r01�.
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) 013 ` -L C
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#