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Richards, Idawanna Ellen NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Idawanna Ellen Richards Female Date'of Death Age If Veteran of U.S.Armed Forces, 02/28/2020 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital W Mannerof Death Undetermined Pending W © Natural Cause �Accident �Homicide �Suicide � � g Circumstances Investigation WMedical Certifier Name Title Enrico Bravo MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 136 Burial Date Cemetery,Crematory or Facility Name 03/09/2020 Pine View Crematorium Entombment Address XJ Cremation Queensbury Town,New York Donation Date Place Removed OF-1 Removal and/or and/or Held H 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 Carleton Funeral Home Inc —700281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom ll.— Remains are Shipped,If Other than Above 2 Address IM W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/02/2020 Registrar of Vital Statistics John Pau(franck(EfectronicaaySiyned) (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: H Z Date of Disposition 3j5(W Place of Disposition uj (address) W N (section) l(lot number) (grave number) G0 h Name of Sexton or Person in Charge of P mises r1 ,ii Z (Plekke print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013400 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#