Starrette, Mach ..„ AZ08
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Macy C.Starrette Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/08/2018 86 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
tp Manner of Death j Natural Cause El Accident El Homicide Suicide 0 Undetermined riPending
Circumstances Investigation
tm Medical Certifier Name Title
Jenny Romero MD
Address
-'. 131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 153
❑Burial Date Cemetery or Crematory
03/09/2018 Pine View Crematory
0 Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
1 Q Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
=- Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
z ; 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
x, s
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/09/2018 Registrar of Vital Statistics John'Eranck(Efectronically Signed)
(signature)
' District Number 4501 Place Saratoga Springs, New York
rou I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3jii (It Place of Disposition f�,1l_i �,,.ci. -
(address)
(section) number) (grave number)
Name of Sexton or Person in Charge of Premises n -flot
' ,S ..it
ir
tease print)Signature Title 12/1C
(over)
DOH-1555 (02/2004)