Tilley, Jean NEW YORK STATE DEPARTMENT OF HEALTh /MI
Vital Records Section Burial - Transit Permit
V Name First Middle Last Sex
Jean M.Tilley Female
„Q Date of Death Age If Veteran of U.S. Armed Forces,
01/31/2018 74 Years War or Dates
10
iz- Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death J Natural Cause El Accident 0 Homicide 1=]Suicide 0 Undetermined Pending
iii
Circumstances Investigation
tro Medical Certifier Name Title
ral Timothy Waters DO
Address
211 Church St,Saratoga Springs,New York 12866
t Death Certificate Filed District Number Register Number
ta City, Town or Village Saratoga Springs 4501 79
❑Burial Date Cemetery or Crematory
02/02/2018 Pine View Crematory
❑Entombment Address
kll®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or
Address
Hold
tol Date Point of
IA r—i
Transportation Shipment
by Common Destination
Carrier
-,LiDisinterment 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
as
Ri 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 02/02/2018 Registrar of Vital Statistics John P Franck(ECectronica/TySigned)
Vii
(signature)
rl 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:
frA Date of Disposition '71 5 hg Place of Disposition g...,Ike (••-c. ..i
(address)
WA (section) I (Jot numb (grave number)
GI
Name of Sexton or Person in arge of Premi s p'u 11., 4n4 4 it
lease print)
pqSignature ./ rnfl
g Title t
(over)
DOH-1555 (02/2004)