UntitledDancz, Karina M. NEW YORKSTATE 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
ll..,, 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
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
0 Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
aDate Point of
N D Transportation Shipment
p by Common
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 orto Whom
F— 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 .7ohn Paul Franck(ElectrorricalySigned)
(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:
i—
Z Date of Disposition 317 12 o Place of Disposition ,«_L
� (address)
W
N (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
0 I (ple a print)
W Signature �/®f/ Title j'
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1 -437 (
Receipt
Human remains of �'`` ;�t �'� 1 >�_ 7 delivered one t" , 20 .`
'r
Pine View Cemetery Representing the ftinerai home named on buriw.permit
Official Funeral Directors Aeg.or License#