Rivette, Pamela NEW YORK STATE DEPARTMENT OF HEALTH
it 2.2
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ti Pamela Lynn Rivette Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/07/2018 51 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Deathpal Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Bert Pyle MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 154
*ID Burial Date Cemetery or Crematory
a, 03/14/2018 Pine View Crematory
3❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
451
El Disinterment Date Cemetery Address
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,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.
t5 Date Issued 03/10/2018 Registrar of Vital Statistics John cPTranck(E(ectronicallySigned)
(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:
f4 Date of Disposition 3 I Ib lI$ Place of Disposition
(address)
(section) //(lot number) (grave number)
Name of Sexton or Person in Charge of remises �, ` -
(pease print)
,,
rt Signature � Title
(over)
DOH-1555 (02/2004)