Nicholson, Joanna t ti .
NEW YORK STATE DEPARTMENT OF HEALTH S�
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
Joanna H. Nicholson
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 27 / 2018 80 War or Dates
14 Place of Death Hospital, Institution or
z City, Town or Village Saratoga Springs Street Address 24 Lakeview Road
aManner of Death❑Natural Cause Accident El Homicide E Suicide ❑Undetermined ❑Pending
IL/ Circumstances Investigation
tu Medical Certifier Name Title
Lynn L. Hickey MD
Address
1184 NY-50, Ballston Lake, NY 12019
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs LI 01 25 /
<< °Burial Date Cemetery or Crematory
04 / 30 / 2018 Pine View Crematory
'iti DEntombment Address
nCremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
tt Hold
O. Date Point of
Q Transportation shipment
a by Common Destination
Carrier
ID Disinterment Date Cemetery Address
<. Q Reinterment Date Cemetery Address
ini
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
vi
iiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
re
"` Permission is h reby ranted to dispose of the human re ains s p bed ally d.
iiiii:i11 Date Issued -) " I , Registrar of Vital Statistics
(signature)
District Number H ;,c)( Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
U.i Date of Disposition c/i /fig Place of Disposition Rau-., 4,f-tin...,
(address)
COla
IC (section) _dot number (grave number)
CI
Name of Sexton ar Person Charge f Premises ( L, J+-'(
(pie se pant) •
Signature Gam` Title jf'E 11WL
(over)
DOH-1555 (02/2004)