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Sloan, Bertha V.
� 31� NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bertha V.Sloan Female Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2020 91 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc pManner of Death © Undetermined Pending W Natural Cause Accident Homicide Suicide C.) Circumstances Investigation W Medical Certifier Name Title Rick Teetz MD Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 204 ❑Burial Date Cemetery,Crematory or Facility Name 04/06/2020 Pine View Crematory Entombment Address ICremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held E—asHold Address O I- Date Point of to ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Otherthan Above Address ilr W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/06/2020 Registrar of Vital Statistics John Paul Franck(Electronically 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: I— Z Date of Disposition ^to Place of Disposition W 2 (address) W /section/ (lot numb (gra ve number) O Name of Sexton or Person in Charge of Premises Z please print) LU Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) -' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#