Natale, Amelia 4, IN # 81
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
Amelia Natale Female
>i Date of Death Age If Veteran of U.S. Armed Forces,
10 / 10 / 2018 88 War or Dates N/A
14 Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address 11 Kirby Road, Apt 17
p Manner of Death Natural Cause 0 Accident 0 Homicide ❑Suicide �Undetermined 7 Pending
Ul Circumstances Investigation
j Medical Certifier Name Title
P. Theodoros Laddis MD
Address
254 Church Street, 2nd Floor, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs _ b' 5 3(
0Burial Date Cemetery or Crg��matory `�
10 / 10 / 2018
Mm
Entombment Pine View Crematory
Address
II 0 Cremation Queensbury, Ny
Date Place Removed
Q❑Removal and/or Held
.... and/or Address
ilt Hold
0.
C) Date Point of
Transportation Shipment
a by Common Destination
iliii Carrier
Disinterment Date Cemetery Address
Mii
Q Reinterment Date Cemetery Address
lii Permit Issued to Registration Number
tg Name of Funeral Home Compassionate Funeral Care 00364
Nii Address
3 402 Maple Ave., Saratoga Sp., NY 12866
ft
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
1r.
U1
Pii Permission is he eby ranted to dispose of the human remainiescribed above as indicated.
iN Date Issued f l7 Registrar of Vital Statistics C0--LT
-4111404
iiiiiF
(signature)
District Number gsb1 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. p
1,11 Date of Disposition /D/ll 10 Place of Disposition f`e411�., ��,,.et0istfr,
2 (address)
VI
Et (section) /'1itsr
(lot number) (grave number)
QName of Sexton or Person ip Charge of Premises - Aok
1�
z4 ' (pl se print) .
Signature Title 1N.
(over)
DOH-1555 (02/2004)