Boldt, Jason A. �oo
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Emily Nancy Pierce Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/21/2020 101 Years War or Dates
II.— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 81 Crescent Street 31 B,Saratoga Springs,New York 12866
W
p Manner of Death Q Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Tammy Wheeler PA
Address
15 Maple Dell 1,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 181
Burial Date Cemetery,Crematory or Facility Name
03/23/2020 Pine View Crematory
Entombment Address
01,11
Cremation Queesbury,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
F—N Hold Address
O
IL Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
j0 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 orto Whom
I-- Remains are Shipped,If Other than Above
Address
C
LU
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/23/2020 Registrar of Vital Statistics .74a Paul'Franck(EkCtrOnicad So zed)
(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:
W Date of Disposition _3 —god Place of Disposition 2 -1!r-
LU address
W
N (section) (lot numb,/ (grave number/
0 Name of Sexton o=Personin of Premis z /(p lease print)
WSignature ! Title
DOH-1555(07/18)p 1 of 2
l
J
Public Health Law Sec. 4145(2b) R 013456
Receipt
1
Human remains of delivered on , 20
t'
Pine View Cemetery Representing the funeral home named on'burial permit
Official Funeral Directors Reg.or License#