White, Mary 1/1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
/O Name First Middle Last Sex
Mary Elizabeh White Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/21/2018 88 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death gi Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending
Circumstances Investigation
,- 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 465
El Burial Date Cemetery or Crematory
N 09/03/2018 Pine View Crematory
"' ❑Entombment Address
®Cremation .Queensbury Town, New York
t Date Place Removed
❑Removal and/or Held
`� and/or� Address
<. Hold
Date Point of
1DestTransportation Shipment
by Common
ination
Carrier
El Disinterment Date Cemetery Address
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 or to Whom
fr Remains are Shipped, If Other than Above
a. Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/22/2018 Registrar of Vital Statistics John 2 Franck(T1 ctronica1TySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
2 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ui Date of Disposition I Ie jig Place of Disposition tµ�,, [t4 n 0I ..I
(address)
tri
re (section) J(lot number) C (grave number)
4 Name of Sexton or Person in Charge of Pre *ses /At1iiriit anew
Z (plea print)
Signature '"l Title lttenittt/A4
(over)
DOH-1555 (02/2004)