Parkhurst, Carol Helen 55s
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carol Helen Parkhurst Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/09/2020 80 Years War or Dates
F Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
UCircumstances Investigation
0 Medical Certifier Name Title
Jennifer Denis NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 P74
Burial Date Cemetery,Crematory or Facility Name
05/12/2020 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
d Date Point of
to ❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
10 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 orto 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 05/11/2020 Registrar of Vital Statistics .7o&PaulFra,7ck(!Efectro iicaff S6rned)
(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:
Date of Disposition Sl0 Place of Disposition ,
W (address/
W
Ir N (section/ (tot number), (grave number)
aName of Sexton or Person in Charge of Premises '
Z (pi se print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01,3787
Receipt
Human remains of delivered on , 20
f,
1
Pine View Cemetery Rep•Qsentmg the funeral home named on burial permit
Official F irectors Reg.Qr e#