Livingston, Donna if
NEW YORK STATE DEPARTMENT OF HEALTH %" i?g
Vital Records Section Burial - Transit Permit
' Name First Middle Last Sex
Donna Q.Livingston Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/31/2018 77 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death Irej Natural Cause Ej Accident 0 Homicide p Suicide 7Undetermined 7 Pending
Circumstances Investigation
{r Medical Certifier Name Title
4' Mark Weidner MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
, City, Town or Village Saratoga Springs 4501 209
,. ❑Burial Date Cemetery or Crematory
04/03/2018 Pine View Crematory
❑Entombment Address
i ®Cremation Queensbury Town, New York
Date Place Removed
.,, ❑Removal and/or Held
and/or
Address
Hold
F4 Date Point of
❑Transportation Shipment
a. by Common Destination
Carrier
- ❑Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
; Permit Issued to Registration Number
ti, 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
h` Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/03/2018 Registrar of Vital Statistics ,John P Eranck(E(ectronicalty Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
'± I certify that the remains of the decedent identified above were disposed of in accordance7 with this permit on:
Date of Disposition 11/3 iI ' Place of Disposition �;,�IY--' (rho
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises ,
(please print
Signature G..r 4 Title "r" —
(over)
DOH-1555 (02/2004)