Mistler, Jeanne I/ iro
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeanne Mistier Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/02/2018 92 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Clifton Park Town Street Address Seton Health At Schuyler Ridge Residential Healthcare
Manner of Death 0 Natural Cause 0 Accident 0 Homicide El Suicide ri Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Donald Jue MD
Address
1 Abele Blvd,Clifton Park Town,New York 12065
Death Certificate Filed District Number Register Number
City, Town or Village Clifton Park 4552 18
❑Burial Date Cemetery or Crematory
02/06/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
- Date Place Removed
` ❑Removal
and/or and/or Held
Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Date CemeteryAddress
❑Disinterment
;; Date Cemetery Address
, ❑Reinterment
Permit Issued to Registration Number
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
M Address
Permission is hereby g dispose to dis ose of the human remains described above as indicated.
Date Issued 02/05/2018 Registrar of Vital Statistics Patricia O'c(onne(((E(ectronicaffySigned)
(signature)
District Number 4552 Place Clifton Park, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
11 Date of Disposition -44 — Place of Disposition fiktq.J e.+•i,`f6t'1..•i
(address)
w Zil lit
(section) (lot num (grave number)
Cx Name of Sexton or Person in Charge of Premises Zit_'L
lease print)
r:
Signature Title PR AIX
(over)
DOH-1555 (02/2004)