Bentley, Peggy NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peggy Bentley I Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/09/2020 86 Years War or Dates
F Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Mark Weidner MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 155
Burial Date Cemetery,Crematory or Facility Name
03/12/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
i-N Hold Address
O
t1 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
Remains are Shipped,If Otherthan Above
Address
cc
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/12/2020 Registrar of Vital Statistics •74n Paul!ranck(Ekctronicaf Sonedl�
(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:
WDate of Disposition 3 I13 ZO Place of Disposition
2 (address)
W
N (section) (lot number) (grave number)
Cc A
G Name of Sexton or Person in Charge of P emises
(pl se print/Z
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) : , 01 3 A 2 2
Receipt
Human remains of fr delivered on 20-
Ph e View Cemetery Representing the funeral home named on burial permit
'Official Funeral Directors Reg.or License#; T
E