Olsen, Donna J. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donna J Olsen Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/09/2020 74 Years War or Dates
II.- Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
`p Manner of Death ❑X Natural Cause Accident Homicide 1:1Suicide El Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Brittany Miske NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 150
Burial Date Cemetery,Crematory or Facility Name
03/10/2020 Pine View Crematory
Entombment Address
ICremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
~N Hold Address
O
d 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 Other than Above
Address
W
o- Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/10/2020 Registrar of Vital Statistics .7olnr Paul Franck(Ekctronicaf Signed)
(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-l �-- , Place of Disposition
LU (a dress)
W
NIX (section) (tot number) (grave number)
0 Name of Sexton or Person in Charge of Premises ('rn
Z (please print)
W Signature Title t✓d�vy`+c�
DOH-1555(07/18)p t of 2
1
I
Public Health Law Sec. 4145(2b) `t 01 %1 4 1 4
Receipt
Human remains of delivered on , 20
M
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#