Wimberley, Kay NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Female
Kay Wimberley
Date of Death Age If Veteran of U.S. Armed Forces,
05/26/2018 82 Years War or Dates
Place of Death Hospital, Institution or
l City, Town or Village Saratoga Springs Street Address Saratoga Hospital
rit Manner of Death„Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined 17 Pending
fil Circumstances Investigation
l i Medical Certifier Name Title
Catherine Dawson MD
1, Address
211 Church St,Saratoga Springs,New York 12866
,:.6
Death Certificate Filed District Number Register Number
City, Town Or Village Saratoga Springs 4501 294
1 ❑Burial Date Cemetery or Crematory
05/29/2018 Pine View Crematory
❑Entombment Address
'4®Cremation Queensbury Town, New York
7 Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
: by Common Destination
Carrier
Date Cemetery Address
Q Disinterment
:. Date Cemetery Address
Q Reinterment
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
Remains are Shipped, If Other than Above
Address
5
f
Nii
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/29/2018 Registrar of Vital Statistics John'Pranck(VectronicalTy 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:
Date of Disposition 5=3r/ Place of Disposition Rj,!{U4.�,,�1 zir p,1 0,:wei-_
-° (address)
Oh
(section) (lot number)o (grave number)
ritit Name of Sexton or P rson 'n Charge of Premises 57e,he�" /4.4..�'SS
(please print)
Signature
v-.--' Title ertirt44 o A-
tm
(over)
DOH-1555 (02/2004)