Love, Mary .. , , t 715"
NEW YORK STATE DEPARTMENT pF HEALTH 4Vital Records Section Burial - Transit Permit
€ Name First Middle Last Sex
Mary Elaine Love Female
;. Date of Death Age If Veteran of U.S. Armed Forces,
08 / 28 / 2018 89 War or Dates
14 Place of Death Hospital, Institution or
WCity,Town or Village Wilton Street Address is Oriole Court
0 Manner of Death®Natural Cause 0 Accident L.1 Homicide 0 Suicide �Undetermined �Pending
lu Circumstances Investigation
tii Medical Certifier Name Title
Q Gloria Ethier MD
Address
15 Maple Dell, Saratoga Springs, NY 12866
iiM
Death Certificate Filed District Number �56,q Regis tuber
City, Town or Village Wilton
`<DBurial Date Cemetery or Crematory
08 / 291 2018 Pine View Crematory
<` LlEntombment Address
nCremation Queensbury, NY
Date Place Removed
2❑Removal and/or Held
3 and/or Address
Hold
CA
0 Date Point of
Transportation Shipment
0 by Common Destination
Carrier
0 Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
iNi:>< Permit Issued to Registration Number
gik Name of Funeral Home Compassionate Funeral Care 00364
>a Address
402 Maple Ave., Saratoga Sp., NY 12866
gii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
. Address
i .
ICE
Permission is hereby
granted to dispose of the human remains described above gi
>` as indicated. \
Date Issued g/ )/18Registrar of Vital Statistics " . E signature)
District Number /-/6(p ci Place Wilton , New York
Vig
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
rii
ill Date of Disposition 114+(s Place of Disposition f,.i)..d niitOw--
(address)
tia
w
Et (section) (I number) (� (grave number)
Name of Sexton or Person i,p Charge of Pre isesr4 J �'"°
(please pprint) •
tit 6Signature Title ( 1/(
(over)
DOH-1555 (02/2004)