Dancz, Katrina M. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Katrina M Dancz Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/27/2020 50 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined �Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
C3 Anthony Perniciaro Coroner
Address
45 NATIVE DANCER LN,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 135
Burial Date Cemetery,Crematory or Facility Name
03/02/2020 Pine View Crematory
Entombment Address
KCremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
N
u— Hold Address
O
(L 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 Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
�. Remains are Shipped,If Other than Above
Address
W
n" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/02/2020 Registrar of Vital Statistics 7o,n rPaul Franc�(EYctrouicalySigne o
(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:
Z Date of Disposition _ Place of Disposition
� (address)
W
N (section/ (lot number/ (grave number)
Q e
aName of Sexton or Person in Charge of Premises /Ple e print/Z
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) I �`
Receipt
Human remains of ! r 7 ;l Adelivered on }`` , 20
,1
Pine View Cemetery Representing the funeral home named on buri-O.R—ermit
Official Funeral Directors keg.or License#