Morse, Evelyn I. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Evelyn I.Morse Female
Date of Death Age �Veteran of U.S.Armed Forces,
04/07/2020 102 Years Dates
II.— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
LU
p Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined Pending
W1:1
U Circumstances Investigation
QW Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 211
❑Burial Date Cemetery,Crematory or Facility Name
04/09/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
H and/or and/or Held
N Hold Address
O
IL Date Point of
CO) ❑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 700364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
F. 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 04/08/2020 Registrar of Vital Statistics ,74,7 P--1 Tranc,E(ElectronicaQ Srgned)
(signature/
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disp of in accordance with this permit on:
H
Z Date of Disposition ,,, '9 i ZD71�Place of Disposition
u1 �Plt I /� t f tJ Z)
2 (address)
W
N
tr (section)" Q (lot number) (grave number)
Name of Sexton or Person in Char of Premis
Z (Please print)
LU Signature Title U,127-�a
DOH-1555(07118)p 1 of 2
. 0-0
Public Health Law Sec. 4145(2b) 013522
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# f;