Whitney, Camille (2) NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Camille Whitney Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/15/2020 58 Years War or Dates
II— Place of Death Hospital,Institution or
Z City,Town or Village Wilton Town Street Address 188 Ruggles Road,Wilton Town,New York 12866
W Manner of Death
Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
LU 0 Medical Certifier Name Title
Tammy Wheeler PA
Address
11 Hampstead N Place 103,Saratoga Springs,New York 12866
Death Certificate Filed District Number register Number
City,Town or Village Gansevoort 4569 9
Burial Date Cemetery,Crematory or Facility Name
03/18/2020 Pine View Crematory
Entombment Address
i Cremation Queensbury Town,New York
❑Donation
0 ❑Removal Date Place Removed
and/or and/or Held
l—asHold Address
O
4. Date Point of
fA ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
ir-1 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
i— Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/18/2020 Registrar of Vital Statistics Susan Ballwin��Yecmonicaf Stoned)
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l-
Z Date of Disposition ,3�9 ZcYi� Place of Disposition
LU (address)
W
N cc (section) (lot number (grave number)
0 Name of Sexton or Person in Charge remises -
Z / ease
print/
W Signature f Title �
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1 013439
Receipt
Human remains of a°t 3' delivered on , 20
f`
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# T?