Tracy, Sylvia if 513
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
" Name First Middle Last Sex
Sylvia Tracy Female
'J Date of Death Age If Veteran of U.S. Armed Forces,
07/15/2018 93 Years War or Dates
Place of Death Hospital, Institution or
Citiiiy, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide El❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 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 399
❑Burial Date Cemetery or Crematory
07/17/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
`' Date Place Removed
SEl Removal and/or Held
i""and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
` Carrier _
4'0 El
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
cry Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
1 A• ddress
" 53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/16/2018 Registrar of Vital Statistics John 4'Eranck(E(ectronica((ySigned)
(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:
M D• ate of Disposition Mg ill Place of Disposition (2/1,1/4.— �a
(address)
(section) n"(lotnumber)� (grave number)
0 Name of Sexton or Person in Charge of Premises ( utp� _) 4II)
z (plbase print)
W S• ignature Title l rs10--
(over)
DOH-1555 (02/2004)